Wound care
Honey was one of the first ingredients used for the healing of wounds, and is still commonly found in advanced dressings today.
treatment, but it’s clear that our intellectual ancestors were onto something: Egyptians are thought to have conceived the first adhesive bandage using honey (among other things), which is still an ingredient in many of today’s advanced dressings. The Greeks emphasised the importance of hygiene, washing the wound with clean water and using vinegar to keep infection at bay much like acetic acid is used today.
“In order to move the discipline of wound care closer towards science, both in research and by standardising care in the clinic, there’s a need to cultivate interest in the topic among the medical profession.”
Probst explains that things didn’t move forward too significantly from there until Florence Nightingale took the role of hygiene a step further and worked with political incumbents during the Crimean war to introduce sanitation as a best practice. This was both in the care of wounds, which meant they were always to be washed and bound with clean bandages, and in the wider hospital system, where handwashing and disinfecting the surroundings became mandatory. “The mortality rate dropped drastically,” says Probst. The next big advancement came in 1962, when George D Winter demonstrated the benefits of a moist environment for healing wounds. “He showed on pigs that if you take a moist gauze and put it on the skin, the healing process is much faster, and there is less scarring,” adds Probst.
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Spoilt for choice
An associate professor of tissue viability and wound care at the University of Applied Sciences and Arts Western Switzerland, Probst’s time is split between teaching and research, but also clinical practice, where he sees no shortage of products vying for pole position as the go-to option for practitioners. This is especially true for advanced dressings and with bodies of scientific literature supporting them, as well as negative pressure wound therapy machines and some of the more recent innovations, like tools that measure the bacterial load of wounds, Probst describes the situation as “a jungle”. “If I have all of these different devices in the outpatient clinic, where shall I put the patient?” There’s a tone of levity to Probst’s question, but the challenge of selecting the right tools in a market brimming with options is quite serious. One reason for the difficulty is that the endpoint, or primary outcome, that’s measured in wound care studies, tends to only be wound-size reduction. While Probst says wound-size reduction is “a very good outcome”, he argues that other endpoints should be added too, like prevention of infection, or reduction of bacterial load. “How many bacteria you have on a wound can cause, for instance, a local infection, which can lead to a systemic infection,” Probst adds.
When we consider another important endpoint raised by Probst, the “quality of life” of patients, it’s easy to see why wound-size reduction shouldn’t be the be-all and end-all in research. Many patients with chronic or non-healing wounds are elderly, with comorbidities that may prevent a wound from ever healing, and in this case, it’s worth exploring whether
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