Wound Care Basics: Bandages and Skin Moisture
- Publish Date: 2014/01/13 - (Rev. 2017/11/06)
- Author: Thomas C. Weiss
- Contact : Disabled World
Outline: Information regarding proper skin care by dressing and caring for wounds to help prevent infection.
For caregivers of a loved one's wounds, the most important job is to prevent infection; not only because infections can lengthen the healing process, but also because certain infections have the potential to be life-threatening. It is important to wash the wound at least once each day with plain water or a mild cleanser. Soaking may help to remove scabs and dead skin. Do not use harsh cleansers or scrub too hard, it may cause further damage to the wound.
Antibiotic ointments may also help. It is important to communicate with your loved one's doctor about which, if any, particular ointment would be best to use. Other ointments such as regular Vaseline might also be a good idea because they keep a person's skin moist and help to prevent bandages from sticking to the wound and causing more damage.
Chart showing bandage types
Some different issues exist when you examine different types of bandages. Generally, dry bandages should be avoided as they tend to cling to a wound and cause damage when you remove them. The same is true for adhesive bandages such as Band-Aids. Teflon patches work in some instances, but they might stick to some types of wounds. Silicone bandages are costly, although they may help to keep a wound moist and are easy to remove.
It is important to remember that almost no type of dressing or bandage will be useful throughout the entire course of the healing process. As the condition of a person's wound changes, a doctor will most likely recommend changes in their treatment. Consistent communication between you and the person you, the person you are caring for and their doctor is the key to preventing infection while helping the wound to heal as quickly as it can.
The Effect of Failing to Control Skin Moisture
Most people are familiar with the skin changes that happen after spending too much time in a hot bath. The skin changes are characterized by softening, swelling and wrinkling of the epidermis. The effects are usually assumed to be caused by absorption of the bath water by the outer layer of a person's skin. The water then permeates the inter-cellular spaces, crosses cell membranes and swells the corneocytes.
The same changes can happen from simple occlusion - for example, by the extended use of plastic or rubber disposable gloves. The fairly impermeable nature of the materials finds moisture accumulating within the person's skin, resulting in the same softening and wrinkling.
It is probable that the skin changes that happen from prolonged immersion in a bath result not simply from absorption of water by the outer layers of the person's skin, but also by the accumulation of moisture in the deeper layers caused by the skin's inability to transpire excess water away in the form of sweat. In a hot bath, the situation is actually worsened by the fact that the person's capillaries within their skin are dilated as their body tries to produce increased sweat as part of its usual temperature-regulating process.
Chart showing the effects of skin moisture level
Despite the cause, the obvious change in the thickness and appearance of a person's skin is reversible and does not usually represent any serious threat. However, while in this condition the person's skin is more susceptible to physical damage and its protective barrier properties to microorganisms and chemicals are impaired. Occluded skin has also been shown experimentally to be more sensitive to irritants.
When exposed to a warm and dry environment, a person's skin returns to usual in minutes and does not require treatment. The application of any form of oily skin preparation or skin protectant would only impair the recovery process. The treatment of certain dermatological conditions; however, associated with the formation of cracked or dry skin, finds the effect greatly desired. In these situations, oily emollients added to the person's bath, which form a film on the surface of the water, are transferred to the person's skin as they rise out of the water. The thin, oily layer helps to conserve any additional moisture.
The skin changes described are very different from ones often observed around the margin of chronic wounds like leg ulcers. While these skin changes might be due in part to maceration, which predisposes the affected area to traumatic injury, a second factor is the presence within chronic wound fluid of proteolytic enzymes. These can chemically degrade skin that is exposed, resulting in a red and weeping surface. In these situations, a barrier cream or a dressing that provides an effective seal to the skin is most likely called for to provide a protective function.
Another commonly encountered cause of superficial skin damage is the presence of feces or urine on the surface of skin; the irritant nature of these may lead to superficial damage. Diaper dermatitis is a common condition with several types. Fecal enzymes also have a deleterious effect on skin. In senior or immobile people, maceration secondary to incontinence of feces or urine is at times regarded as a precursor to skin damage caused by pressure and shearing effects, leading to formation of pressure ulcers.
Adults and children who are neglected or obese also experience, 'intertrigo,' or excoriation or chafing between moist skin folds and adjacent surfaces. All of these areas are susceptible to infection with Candida albicans. Where skin is at risk, it is possible to apply topical agents such as zinc paste or proprietary skin protectants that are quicker and easier to apply and remove and which have the advantage of being transparent. While the presence of liquid is a major contributory factor in these conditions, the skin does not have to be completely macerated in order for damage to happen.
In contrast, conditions that lead to a depletion of the moisture content of a person's skin might also produce visible changes of differing severity. Each year pharmaceutical and cosmetic companies spend millions in developing and promoting products designed to improve the moisture content of a person's skin and reduce the appearance of wrinkles and lines.
If the moisture content of a person's skin is seriously depleted to below 10%, it may result in dryness and lead to chapping or cracking - especially on a person's knuckles or fingertips. In some instances, total dehydration caused by death of the underlying dermal structures leads to the formation of a dry, black and leathery, 'eschar,' commonly associated with pressure ulcers.
If the integrity of a person's epidermis is seriously compromised by trauma or a metabolic or physiological disorder, the healing rate of the resulting wound is influenced by the moisture content of the surrounding skin and the local environment. If the epidermis is too dry, epithelialization will be delayed. If it is too wet there is a risk of maceration and infection. These conditions are determined mainly by the choice of dressing.
Along with facilitating healing, a product that maintains a moist environment might also help to prevent secondary damage to a vulnerable area of tissue that happens as a result of dehydration. The capacity of deep partial thickness wounds to undergo spontaneous healing is dependent upon the survival of epidermal cells in hair follicles and sweat glands in the base of the wound. If these are permitted to become dehydrated and devitalized the wound might actually become bigger and convert from a partial thickness to a full-thickness injury.
Application of an occlusive dressing will save not only dermal tissue, but also certain epithelial elements in the area of stasis surrounding the original injury. The use of traditional dry dressings in these situations may result in progressive dehydration of the area, followed by de-vitalization and necrosis, with the result of the zone becoming indistinguishable from the original wound. The prevention of dehydration by the application of a suitable occlusive or semi-permeable dressing might limit or prevent these secondary effects.
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