The Evolution of Wound Care

Prehistoric:

It was observed that wounds bled less and perhaps historic healed faster when bandaged. Leaves and grass were used.[10]

1650 BC:

Egyptians discovered that closed wounds healed faster than open wounds. They created the first adhesive bandage by applying gum to linen strips in order to draw wounds together.[10]

1600s to 1960s:

Wound care treatments developed minimally between the 1600s and the 1960s. Dressings were used to cover 1960$ and protect the wound from exposure to the external environment.1600s Dressings used in treatment included cotton linters, paper, feathers, and dust.[6]

1600s:

Dressings used in treatment included cotton linters, paper, feathers, and dust.[5,6]

1800s:

Patients treated with dressings such as linters, cotton gauze, knitted fibers, and fibers. 1900s Focus on covering the wound continues with the use of non-woven swabs, sleeve dressings, adhesive paper, and planters/wipes.[6]

1867:

Lister introduced antiseptics to wound care with the use of carbolic acid and phenol.[18,19]

1962:

Landmark study by Winter finds that moist. Wounds were epithelialized more rapidly than dry wounds.[1]

1963:

Polyethylene film first made available commercially.[2]

1970s:

Medical research and practice continue to recognize moist wound healing as the standard of care.[6]

1971:

Winter finds that “wounds resurfaced faster when covered with a plastic material than those left open to the air.”

1979:

Hunt observes visible fibroblast activity in a wound within a couple of days of the injury.[1]

1980s:

Moist wound healing continues to revolutionize wound care treatment. An influx of product innovations such as plastic films, hydrocolloids, gums, and hydrogels reach the wound care market.[6]

1981:

The dermis of superficial wounds exposed to air is more fibroblastic fibrotic and scarred than the dermal component of a similar wound maintained in a moist environment.[1]

1982:

Hydrogels become commonly available. Research confirms moist healing as the most effective wound treatment.”[13]

1983:

In studies using hydrocolloids, researchers confirm that the healing of normal wounds is significantly enhanced in a moist environment in comparison to wounds that are allowed to dry or those treated with wet-to-dry gauze.[14]

1985:

Further investigation of Collagen’s role in wound healing. Studies indicate that wounds subjected to a moist healing environment reepithelialized more rapidly than similar wounds exposed to air.”[15]

1986:

In wound healing cost-effectiveness studies, Trelease finds that “occlusive (moist) dressing have demonstrated to be more cost-effective than traditional dressings.“[16]

1989:

Alvarez finds that povidone-iodine, peroxide, and Dakin are cytotoxic to wounds and impede healing. Update: There is a non-cytotoxic Dakin’s brand available. Rodeheaver adds to prior research findings that antiseptic agents are reactive chemicals that are cytotoxic to normal tissue.[20]

1990s:

In the past, product innovations demanded health care practitioners’ attention. The trend in the 1990s is to focus on the impact of information on wound treatment. For example, outcomes-based wound healing – a philosophy introduced by the managed care system – demands that medical professionals provide a definition and comparison of what treatment or therapies work, at what cost, and in what length of time.[7]

2000s:

Researchers’ project increased the development and use of biocompatible and bioabsorbable materials.[15,17] Dressings will actias delivery system for active agents, growth factor, debridement agents, etc. to create ideal environments for the healing process.
The future will focus on wound care information innovations rather than the product innovations and topical therapy revolutions that characterized the 1980s. The goal of the 1990s and beyond will be to stay updated on current data and technological advances.[7]

References:

  1. Avlare O,Rozint J, Wiseman D. Moist Environment for Healing: Matching the Dressing to the Wound. WOUNDS 1989;1:35-51.
  2. Alvarez OM, Hefton JM,Eaglestein EW. Healing Wounds: Occlusion or Exposure.Infection in Surgery 1984;3: 173-181.
  3. Alvarez OM, Mrtz PM, Eaglstein WH. The Effect of Occlusive Dressings on Collagen Synthesis and Re-Epithelialization in Superficial Wounds.Journal of Surgical Research 1983;35:142-148.
  4. Bates-Jensen B. Wound CARE: An Acronym for Action.JWOCN 1995;22(5):206-209.
  5. Geronemus RG, RObins P.The Effect of Two New Dressings on Epidermal Wound Healing.J Dermatol Surg Oncol 1982;8:850-852.
  6. Hinman CD, Maibach H. Effect of Air Exposure and Occlusion on Experimental Skin Wounds.Nature 1963;200(4904): 377-379.
  7. Hunt Tk, Van WInkle W. The Fibroblast in Normal Repair. In: Hunt TK, Dunphy JE, eds. Fundamentals of Wound Management. New York: Appleton Century Crofts, 1979:17.
  8. Leipziger LS, Glushko V, DiBernardo B,et al.Dermal Wound Repair: Role of Collagen Matrix Implants and Synthetic Polymer Dressings.Journal of th American Academy of Dermatology 1985;12(2):409-419.
  9. Linsky CB, Rovee DT, Dow T. Effect of Dressings on Wound Inflammation and Scar Tissue. In: Dineen P, Hildick-Smith G, eds. The Surgical WOunds. Philadelphia: Lea & Febejer, 1981:191-205.
  10. MedStrat Inc. Wound and Burn Management 2000.1989.
  11. Melchior-MacDougall F, Lander J. Evaluation of a Decision Tree for Management of Chronic Wounds. JWOCN 1995;22:81-88.
  12. Trelease C. A Cost-Effective Approach for Promoting Skin Healing. Nursing Economicas 1986;4(5):265-266.
  13. Winter GD. Formation of the Scab and Rate of Epithelialization of Superficial Wounds in the Skin of the Young Domestic Pig. Nature 1962;193(4812):293-294.
  14. Winter GD, Clarke DW. The Pig as a Laboratory Animal for Study of Wound Healing and Surgical Dressings. In: Harkiss KJ, ed. Surgical Dressings and Wound Healing. London Crosby Lockwood: 1971:61-69.
  15. Wound Ostomy and Continence Nurses Society. Standards of Care – Patient with Dermal Wounds: Lower Extremity Ulcers. Costa Mesa, CA: WOCN, 1993.
  16. Wound Ostomy and Continence Nurses Society. Standards of Care – Dermal Wounds: Pressure Ulcers. Costa Mesa, Ca: WOCN, 1992.
  17. Zitelli JA. Delayed Wound Healing with Adhesive Wound Dressings. Dermatol Surg Oncol 1984; 10:709-710.
  18. Linsky CB, Rovee DT, Dow T. Effect of Dressings on Wound Inflammation and Scar Tissue. In: Dineen P, Hildick-Smith G, eds. The Surgical Wound. Philadelphia: Lea & Febejer, 1981:191-205.
  19. Aldea PA, Aldea GS, Shaw WW. A Historical Perspective on the Changing Methods of Management for Major Trauma of the Lower Extremity.Surg Gynecol Obstet 1987;165:549-562.
  20. U.S. Department of Health and Human Services. Clinical Practice Guideline No. 15: Treatment of Pressure Ulcers.1994.