Hydrotherapy in the Treatment of Non-Healing Wounds
For the treatment of wounds, it is crucial how they are managed during the cleaning and granulation phases. For most non-healing wounds, so-called Hydrotherapy (treatment with hydroresponsive dressings) is suitable, which involves just two steps. The essence of Hydrotherapy is the maintenance of a moist environment and, if possible, a constant temperature in the wound.
Individual Approach
Not only for the treatment of complicated wounds is the choice of dressing crucial. The specific appropriate type depends on the degree of wound exudation, the presence of fibrin coating, necrosis, or infection, and the depth of the wound. An individual approach is also required, considering patient compliance, skin sensitivity, and any allergies. Hydrotherapy is a simple and effective treatment method with hydroactive dressing, suitable for most types of non-healing wounds (up to 80% of all chronic wounds). It consists of just 2 steps:
- Step: Cleaning the infected, necrotic, or coated wound and initiating healing
- Step: Protecting the wound and supporting its healing (removal of exudate and hydration)
Step 1: Application of Dressing with Ringer's Solution and Superabsorbent Polyacrylate
In the first step, the wound is covered with an absorbent pad soaked in Ringer's solution. The core of the dressing material is made of polyacrylate with superabsorbent properties. This polymer has a higher affinity for exudate with protein content than for ions in Ringer's solution, which gradually releases into the wound for up to 3 days. The exudate, including microorganisms, toxins, and remnants of necrotic tissue, is absorbed into the absorbent core (so-called autolytic debridement). The content of matrix metalloproteinases, which in high concentrations in chronic wounds inhibit the repair process, is also reduced along with undesirable microorganisms. The wound is continuously flushed and cleaned, promoting accelerated healing and granulation tissue formation, partly through the prolonged survival of fibroblasts.
The hydroresponsive dressing is recommended to be fixed with a bandage or plaster. It can also be used in conjunction with compression therapy. Replacement is necessary at the latest 3 days after application. The dressing does not stick to the wound, and a change can be made almost painlessly a few minutes after moistening with Ringer's solution.
Step 2: Hydration with Polyurethane Dressing with Hydrogel
In the second step, a polyurethane dressing with hydrogel (up to 60% water content) is applied to hydrate the wound. The core of soft absorbent polyurethane foam also absorbs exudate, creating an ideal moist environment for complete wound healing (re-epithelialization). The polyurethane foam prevents secondary infection while allowing oxygen access. The proliferation and migration of keratinocytes are stimulated by growth factors.
The same recommendations for fixing the dressing apply as in the first step. The absorbent capacity can be visually checked without removing the dressing – a change should be made when secretion is visible at the edges. The dressing can again be removed painlessly after moistening.
For Which Types of Wounds is Hydrotherapy Suitable?
Hydrotherapy can be used to treat most acute and chronic wounds, whether traumatic or atraumatic. It is suitable in the cleaning phase (presence of fibrin coating, infection, or necrotic tissue), granulation, and re-epithelialization phases.
This treatment method is fully covered by public health insurance. Its advantages include simple use and accelerated healing. Patients will also surely appreciate the reduced frequency of dressing changes, which can be almost painless.
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This article was created with the support of Hartmann-Rico.
Sources:
1. Hydrotherapy. Hydroresponsive Dressing in Just Two Steps. Hartmann-Rico, 2020.
2. Hydrotherapy. Wound Treatment, 2021. Available at: www.lecbarany.cz/odbornik/typy-lecby/hydroterapie
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