There has been increasing experimental evidence suggestive of an impaired response by aging cells to stress. Microarray analysis of human fibroblasts from aged patients reveal a baseline increase in expression of stress response genes.6 This may reduce cell viability and decrease the ability to upregulate the pathways essential in a normal stress response. Impaired blood flow to a wound bed undoubtedly leads to decreased oxygen, nutrients, and cells. Ischemic wound models on several species have demonstrated a major impairment in wound healing.7 Ischemia reperfusion injury has been linked to abnormal tissue healing due to the production of proinflammatory cytokines and oxygen free radicals. Wounds that have reached critical colonization by bacteria also demonstrate a decreased ability to heal due to the metabolic load imposed by bacteria.
What we do know is that wounds are more susceptible to healing in a moist, clean, and warm environment.13 A moist wound bed will allow growth factors and numerous cell types including epithelial cells to migrate, facilitating wound edge contraction.14 To create and maintain this environment, appropriate dressings come into play. There are four basic principles involved in choosing an optimal dressing.15 If a wound proves to be dry or desiccated, it will need hydration. If a wound produces excessive exudates, the fluid needs to be absorbed. If a wound has necrotic tissue or evident debris, it will need debridement. Lastly, if a wound is infected, it needs to be treated with the appropriate antibacterial agent. There are also several other factors that are important when choosing a dressing, such as providing protection to the periwound skin, forming an effective bacterial barrier, conforming to wound shape, producing minimal pain during application and removal, being free of toxic or irritant extractables, not releasing particles or nonbiodegradable fibers into the wound, and maintaining the wound at an optimal temperature and pH. Each set of needs can be met with a corresponding dressing that fits the situation. It is important to remember that as the wound environment changes the dressing also needs to change.
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The effectiveness of iodine in the management of bacterial biofilm is currently unclear, although studies have cited that low-dose, slow release iodone is effective in killing free-floating microorganisms and is therefore a good choice of antiseptic dressing when the intention is to suppress biofilm formation or prevent recontamination.91,92 Thorn et al. studied the antimicrobial effectiveness of silver- and iodine-containing wound dressings against preformed mature biofilms of pathogenic wound bacteria grown in vitro,93 and demonstrated that both dressings exerted an antimicrobial effect against the target species biofilms, although the iodine dressing was more efficacious under the experimental conditions employed. Similar results from Phillips et al. also suggest that sustained release iodine may penetrate biofilms more effectively than silver or PHMB.94
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