By: David Dyer, ATC, VATL

Minor acute cutaneous wounds are common in athletics. In fact, they are so common that proper care for them is often overlooked. When moist wound management is discussed, it is often related to advanced care for chronic wounds with poor healing. However, the principles of moist wound management apply for minor cutaneous wounds as well. Moist wound management significantly improves healing outcomes with few concerns.

There are several benefits of moist wound management, the first of which is infection control. While allowing a scab to form offers some infection protection, scabs are easily torn, crack open, or become dislodged, thereby inviting infection. A properly applied dressing does a better job of preventing infection than a scab.

Another benefit of moist wound management is accelerated healing. A moist environment promotes enhanced cellular transport. The extracellular fluid allows inflammatory and proliferative processes to be accelerated. Compared to a dry wound bed, neutrophils, macrophages, keratinocytes, and endothelial cells are able to move freely in an environment that mimics their ordinary extracellular space. Optimizing the efficiency of these cells allows processes such as epithelialization, angiogenesis, formation of granulation tissue, and collagen deposition to occur quickly. For example, epithelialization of the wound bed is shown to occur up to twice as fast in a moist environment. Rapid healing decreases the chances of developing a chronic wound. It also improves aesthetic outcomes for wounds. Wounds which heal more quickly produce less scarring.

Finally, moist wound management provides greater patient comfort during the healing process. A moist dressing may provide better absorbency for wound exudate. Additionally, a moist dressing is much less likely to stick to newly epithelialized tissue compared to traditional gauze dressings. Modern moist dressings can be worn for extended periods of time, many for several days. Wearing a dressing for a longer period of time prevents unnecessary pain and tissue disruption associated with dressing removal. Lastly, pain can be modulated by covering free nerve endings, limiting their sensitization.

While there are many benefits to moist wound management, some concerns are to be noted. First, a dressing must stay in place to be effective. While moist wound management has a great potential for infection control and optimal healing, it requires frequent observation of the healing process and dressing condition. A dressing that is not staying in place invites infection in a similar way to a broken scab. A poorly adhered dressing also compromises the moist environment. There is also potential for the skin underneath the dressing to become macerated or irritated, particularly with high-discharge wounds.

Moist wound management requires compliance with dressing application. While a scab forms on its own, a dressing must be replaced regularly. In particular, dressings must often be replaced after showering, significant sweating, and when the dressing is damaged or has lost its adhesion. Many moist dressings are designed to be removed easily and may not be suitable for activity without a sufficient bandage to anchor them. Maintaining a moist environment requires time, expense, and some knowledge of cleaning and application techniques.

One last concern is the availability of advanced wound care materials and the education required for their effective use. Many of the products available for moist wound management will not be found in a standard store-bought first aid kit. While a simple adhesive bandage is adequate in many circumstances, there are better options on the market in terms of comfort and infection control. With hundreds of dressing options available, it can be challenging to select an appropriate one. If a moist wound management strategy is employed, it is important to ensure the patient is familiar and comfortable with materials and wound care.

Moist wound management optimizes healing for minor cutaneous wounds commonly seen in athletics. What was once not possible, given a lack of research and availability of advanced wound care materials, is now easily attainable. Moist wound management should be a standard practice for all wounds and not reserved for chronic or challenging wounds. Sports medicine professionals are intimately familiar with bandaging an acute wound on a sideline with a non-stick pad and cohesive tape. While that is certainly an appropriate first aid technique during a sport event, it is equally important that they understand, employ, and teach moist wound management techniques in their clinic or athletic training room.

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About CHKD Sports Medicine

CHKD's sports medicine program offers the most comprehensive care for your young athlete. From diagnosis and treatment to customized rehabilitation plans, we specialize in physical therapy and injury prevention programs for active children and teens. Our team is composed of pediatric orthopedic surgeons, sports medicine specialists, physician assistants, certified athletic trainers and pediatric sports medicine physical therapists.