by Tonny Karlsmark 

Maybe you’ve heard the ‘Mind The Gap’ message being echoed in speakers on train stations around the world. The prospect of getting one’s foot caught in the gap between the platform edge and the carriage makes most people respect the reverberating warning. The consequences of not minding the gap is simply too severe and promises pain in one way or the other.

The ‘Mind The Gap’ warning can apply to wound treatment as well. Dr. Med. Tonny Karlsmark from Bispebjerg-Frederiksberg Hospital in Denmark, emphasises the importance of minding the gap between the wound bed and dressing. The following is Tonny’s own reflections and experience on how to mind the gap and prevent exudate pooling.

Why mind the gap?

To me, minding the gap when treating a wound is just as important as when you get off the train with the risk of damaging your leg. Large amounts of wound exudate in the gap between the wound bed and the dressing can seriously jeopardize wound healing. Here’s why.

Chronic wounds are often a zoological garden of bacteria. In fact, up to 14 different bacterial species can grow in chronic wounds and if they form in clusters and create biofilm, the wound has a higher risk of infection.

Bacteria thrive in humid environments; a high amount of wound exudate present in the gap between the wound bed and dressing will therefore increase the number of bacteria formed.

In addition to increased risk of infections and inhibited wound healing due to a high amount of bacteria, bad management of free wound exudate can cause leakage onto the periwound skin and cause a breakdown of the skin’s barrier. Especially the barrier located in the skin’s upper layer is affected. This is also known as maceration, and when the periwound skin is macerated, one of the most important barrier functions disappears in the skin and the wound may increase in size.

How to secure a moist wound healing environment?

What I often see is that health care professionals use both a filler and a non-conforming dressing to treat the wound, and very often, the wound exudate is not managed properly.

And as I have shown in this article, it is of utmost importance that as much of the wound exudate as possible is absorbed into the dressing to manage the exudate and maintain a moist wound environment. 

My experience with wound healing

All wounds undergo a series of wound healing phases: hemostasis, inflammation, proliferation and the remodeling phase. It is especially in the inflammation phase that the wound is exuding and causing a smaller or larger amount of wound exudate.

Therefore, if the dressing cannot conform to the wound bed, the gap that forms between the wound bed and the dressing may cause exudate pooling.

My professional opinion is therefore that the ideal wound dressing is a dressing that has the ability to conform to the wound bed to prevent the gap between the dressing and the wound bed. By doing so, you may reduce the risk of complications such as maceration, increased risk of infection and delayed healing.