New approach to the wounds bymoist wound healing in Japan.

Yoshihiko Mochizuki M.D. @Tokyo Japan

What is the meaning of wound healing?
I think there are two types of wound healing.
1. True healing ←moist healing
2. Pseud healing ←using disinfectant & gauze

But, almost all Drs. & Nurses don't
know the true healing of the wound.

Burn by boiled water
6yrs girl.
Other girl1 year after
Moist healing

Healing !

No photo
I consulted
the scar.
Nearly same
condition to thegirl on the left
photo.

1 year after
Using disinfectant & gauze

Healing?

The cause of the wounds varies.

But, healing process is same or similar.
So, I think the wounds therapy must be same and simple.

Simple therapy is easy.

Moist healing is easy and simple!

History of moist wound healing is old.
Dr. George D. Winter published the paper about moist
wound healing. (Nature 193:293 1962)
Title :
[Formation of the scab and the rate of epithelisation ofsuperficial wounds in the skin of the young domestic pig.]
In this paper he revealed“epithelialization would proceed twice as fast in a moist
environment than under a scab”

But, moist wound healing did not spread.

Why?
Because of Joseph Listerʼs spellbinding?

Joseph Lister is a British surgeon and a pioneer ofantiseptic surgery.
150 years ago, Dr. Lister believed thatdisinfectants over the wound is essential forwounds healing.

This was called Listerʼs law.
Almost all Drs. believed the Listerʼs law !

Although, many studies suggested that disinfectants
over the wound delayed the healing and produce theugly scar.
1. Dilute povidone-iodine solutions inhibit human skin fibroblast
growth.
Dermatol Surg 2002 Mar;28(3):210-4

2. In Vitro and in vivo studies of local disinfection andwound healing.

Hautarzt 1995 May; 46(5): 319-24

3. Effect of povidone-iodine on wound healing:

J. Vasc. Nurs. 1999 Mar; 17(1):17-23

4. The effects of chlorhexidine digluconate on humanfibroblasts in vitoro.
Etc.

J. Periodontal 1992, Jun; 63(6): 526-32

But, many Drs. Believe the Listerʼs law.

In Japan, from 1996, Dr.Makoto Natsui
＠Nerima Hikarugaoka Hospital Tokyo Japanbegun to treat the wounds by“Moist wound healing”
He is a pioneer of this method.
Maybe, only in Japan,“Moist wound healing” is done.

Before showing the moist healing method
I think considering of the structure of skinand the process of the wound healing isnecessary.

Structure of skinhairsweat ductpores

epithelium
dermisｆat→Attention !!
epithelial cell
exist in theduct!

healing process of superficial wound

Attention!!!
epithelium

dermisfat→Epithelial cells grow from the hair
Pore & sweat duct in the injured region

Injured region

In case of superficial wound, theepithelialization occurred from the hair pore!

White spots revealedthe epithelialization

What is the moist wound healing?

Two principles of the moist wound healing.
1. No disinfectants over the wound
2. Keeping the wound in moist environment

Are these principles right ?

Many Drs. believe that using the disinfectants
and putting the gauze on the wound isnecessary to cure the wound.

But! It’s wrong!

How about disinfectants?
Disinfectants activation time is only 15min.

This is my paper about
iodine on“The Annals of Thoracic
Surgery“.
In that time,
I noticed thatDisinfectants'
Activation time is only15min.
The rest 23hrs45min?
No activation.

But, Many Drs. are afraid of the infection, because I donʼt
recommend using disinfectants.

I always say to such Drs.
“Disinfectantsʻ activation time is only15min.”“If you believe the disinfectants’ effect, you must use
disinfectants every 15 min.”Difference between Structure of the human celland bacterial cell
cytoplasmcell
membranecell wall
Human cell

Bacterial cell

Bacterial cell is stronger than human cell because of cell wall
existence.

Which is more destroyed byDisinfectants?
Human cell? or Bacterial cell?

cytoplasmcellmembranecellwallHuman cell

Bacterial cellIn conclusion 1
Disinfectants destroy the human cell which repair the wound.
Disinfectants prevent the true wound healing.

How about drying of the wound by gauze?

I think the healing process of thewounds are similar to the cell culture.

Cell culture need moist circumference,
which need good liquids.

1 dayFace burn : 0 day
covered by hydrocolloid film

White exudates were observed.
Infection?

No !

This white exudates heals the wounds.
Disinfectants and drying wounds by gauze stop the exudate
secretion.

What are the white exudates?
Exudates contain, the growth factor, cytokine
white blood cells.
Cells around thewounds secrete.

In turn, injured
cells arerepaired.

I think this white exudates are thebest cell culture liquids.

In case of gauze on the wounds.
White exudates(best cell culture liquids) disappeared
and the wounds healing is delayed．

Gauze→Gauze absorb the exudates

woundsskinwhite exudates secretion

In case of moist wound healing.
White exudates(best cell culture liquids) can exist the wounds site.
Then, fast and painless healing is possible!

Cover film which maintain the wounds moist

skinwhite exudates secretion

woundsIn conclusion 2
Drying of the wound by gauze
prevent the true wound healing.

1. No disinfectants over the wound
2. Keeping the wound in moist environment

This is ideal healing
environment in thewound!

The following many merits appear, when you create theideal healing environment by "Moist wound healing“
1. Little pain or no pain→less analgesics.
2. Faster wound healing.
3. Low cost.
4. Less scarring.
5. Better cosmetic results.
6. Infection rarely occurred.→less or no antibiotics
use （1%）
7. Home treatment is available.
8. Minimum hospitalization or minimum treatment
as an outpatient.
9. No scab formation.

10. Patient living far away from hospital is treatedby iPhone with photo. Teletherapy may be possible.

How to do moist healing therapy.
１．Drinkable clean water is absolutely necessary towash the wound everyday without soap.
(Soap is a disinfectant.)
2. Some materials are necessary to keep the wound moist.

Cheapest material is a food wrap film.
Daily change of this material is necessary,
after washing the wound.

3. To observe the wound is absolutely necessary
to evaluate the wound infection occurred or not.

How to do moist healing therapy.
4. If foreign bodies exist in the wound,foreign bodies must be removed.
5. The Vaseline can be spread on the wound.
6. If the pus or hematoma exist under the skin,drainage of the fluid is required.

Some materials using moist wound healing method.

hydrocolloid film

Plus moistR film by Dr.Natsui’s developement

Alginate dressingin the case of bleeding.

KALTOSTAT® ConvaTec

Cheapest material is a food wrap !

21yrs male burn:Using food wrap and Vaseline treatment was done
at home.

Burn after1month

3 months

2yrs boy burn: boiled waterusing food wrap & Vaseline

3days

6 days10 daysCases
1. lacerations
2. abrasions
3. amputations

2014／08／25
2014／08／25

55yrs male diabetic gangrene with MRSA infection.
Below-knee amputation was proposed in another hospital.
He rejected the proposal.

No Disinfectants and keep the wound moist.
DM treated by low carbo diet.ＨbA1c＝9.0→6.0
DM control is necessary to treat such case.

Face injury：1yrs 6month female

1daysOnly 2days

0day
Hydrocolloid film on
the wound0 day15days36days60days155days

1.No disinfectants over the wound
2. Keeping the wound in moist environment
Dr. Natsui’s case33yrs male: Ring finger injury by 100 kg Iron ball.
Another Dr. sutured
the wound.
But, necrosis occurred,
Then the amputationof the necrotic region
was proposed.
He rejected theproposal.

Amputated line which is proposed.

0 days84 days

4yrs boy: left index finger injury by belt conveyor

Injured left finger
3days

16 days

50 days

3 months

Drainage of the pus
Is very important.
Sometimes drainage must beDone for long years.
Although, in such patients, when adequate
drainage is done, they can work, take abath etc. There is a no limit to daily life.
To obtain the adequate drainage,
I use some drains.

Cases of Burn
1.All blisters must removed to protect the infection.
Infection may sometimes occur in the blisters.

2. Vaseline application on the wound will be needed forpain reduction. Drying of nerve ending cause pain!.
Vaseline stop it.
3. In all degree of burn, the treatment is same.

2 days

17days

3days

4days

7days

1yr boy :boiled coffee
12days
22days

1day:crying

6days:
Not crying

1 yr. boy : boiled water

2 days0days

7 days3 months

30 yrs female : burned by boiled water

2014／09／15

2014／09／15
Necrotic skin was removed

2014／10/20

2014／09／15
2month later

Same person?

Yes!

42yrs female
Rt. hand2014/4/22

Burn by boiled oil→moistwound
healing
20days

Teletherapy case! using iPhone.
After moist wound care , severe pain disappeared.
No antibiotics. Just 1day analgesic was needed.
No limit to take a bath or shower.
No Disinfectants and keep the wound moist only!

2014/5/10

Large burn83yrs male：Burn by boiled water
During the treatment of the wounds, always he laughed,because of no pain.
He liked alcohol, he rejected the long hospitalization.

2days

7days

22days1monthdischarged

No Disinfectants and keep the wound moist only!

6monthAccording to the text...
Large burn require IV fluid resuscitation?
Burns >20‐25% TBSA require IV fluid resuscitation
Burns >30‐40% TBSA may be fatal without treatmentIs it true?
TBSA :total body surface area

In the moist healing case,No or minimum IV fluid required.

Why?

These are the answers

The answer No1.
No pain or little pain occurred.
So, the patient can eat and drink.

The answer No 2.
Because of keeping the wound moist, fluid loss
volume from the burn site was a smallamount.

In the case of moist healing,
No or minimum IV fluid required.

Minimum hospitalization.

In the moist healing case,
Skin grafting is rarely required.

Why?
Less scarring and better cosmetic results
are obtained by moist healing.

skin grafting case.

I think this is not the true healing!

Case : pressure ulcer

Open Wet‐dressing Therapy:“ food wrap + pet sheet“Pressure ulcer is a special wound.
In other wounds, cause of the injury wasremoved.
ex. Burn Trauma etc.

But, pressure ulcerʼs causes are aging, poor
nutrition, bedridden state.

The causes of ulcer are not removed.

The food wrap and pet sheet are very thin.
When these thin materials are used to treat
the pressure ulcer, the pressure, shear andfriction reduced.
This method is called “wrap therapy” or“Open Wet‐dressing Therapy”.
Multiple perforated food wrap + pet sheet is a cheapest
and best material and easy to make it.

Open Wet-dressing Therapy wasdeveloped by
Dr.TORIYABE, Shunichi M.D. Japan.

Toriyabe S: published the paper.
“Use of a food wrap as a dressing material.“Advances in Wound Care, 12(8):405‐406, 1999.

How to make the special material forpressure wound. Itʼs easy to do.
We make multiple perforated wrap film.
No 1same function

This is a handmade.
1sheet =0.5R$

This is a Moiskinpad® Hakujuji
Japan. Same function as handmade.
1sheet =2 R$

Food wrap only

7 days
28 days

Food wrap only

O day
84 daysProblems that can be encountered with
“Moist wound healing“#1. Wound infection : 1%
#2. Miliaria or impetigo: 2‐3%

#1. Wound infection
1. Detection of infection is very important.
2. Infection does not mean that bacteria are found inthe wound.
3. Most useful sign of infection is a pain.
4. Sometimes, antibiotics are needed few days, until thesymptoms disappear.
**Long‐term use of antibiotics and use of strong antibiotics cause the infection ofantibiotic‐resistant bacteria.
Antibiotics :penicillin or first‐generation cephalosporin is recommended.

healthy Dr.’s hand’s germ culture

Infected or not infected? Do you use antibiotics?
To be or not to be, that is not a question.
Bacteria always exist in the skin.

If infection occurs,
Celsus' quadrilateral, four cardinal signs appear!

1. pain
2. warmth
3. swelling
4. redness

Aulus Cornelius Celsus (c. 25 BC – c. 50 AD) was a roman encyclopaedist.

Infection? Colonization?
1. Pain+
2. Warmth+
3. swelling +4.redness +1. pain‐
2. warmth‐
3. swelling ‐4. redness ‐MRSA was detected both wounds.

Infection!
Need antibiotics

Infection(‐)=Colonization
no antibiotics need

If infection of the wound occurs…

1. pain
2. warmth
3. swelling
4. redness
appear!
So, Dr. & Nurse must observe the wound
to find out them or not.

Healingdelay

healing

Sands
Foreign body cause infection
and wound healing delay.
Foreign body must be removed.

#2. Miliaria and Impetigo
1. Miliaria is an itchy rash of small raised
red spots.
2. Impetigo is a superficial skin infection.
For preventing these skin problems,
dressings have to be changed everyday
after washing the wound with plenty oftap water.

Hippocrates said, "first, do no harm“.

I say, "first, do no antiseptics“

If you have any questions about moist
healing, please do not hesitate tocontact me.

yomochizuki@nifty.com
In English and with photo, please.