“M.O.I.S.T. will become the basis for the therapy of chronic wounds”
Prof. Dr. med. Joachim Dissemond
Professor Dr. Med. Joachim Dissemond was born in 1968 in Cologne. Since 2003 he is working as a senior physician in dermatology at the University Hospital in Essen. In addition, he is founder and CEO of Wund-D.A.CH, first chairman of the wound healing consortium of the German dermatology corporation (Arbeitsgemeinschaft Wundheilung der Deutschen Dermatologischen Gesellschaft) and member of the Initiative of Chronic Wounds e.V. The entire curriculum vitae of Professor Dr. Dissemond can be found » hier.
The new M.O.I.S.T. concept was developed by an expert group of Wund-D.A.CH and was published first in April 2017 in the Journal of the German Dermatological Society (JDDG) 1. You have been part of this renowned expert group. Why did you develop the T.I.M.E. concept?
Professor Dr. Joachim Dissemond: The successful therapy of patients with chronic wounds is based on diagnosis and the successful treatment of the underlying pathophysiologically relevant diseases. In addition to this, patients should always be treated with a moist wound therapy which is oriented towards each phase of wound healing. The currently available therapy options are very diverse, which makes it difficult for many therapists to keep an overview in clinical practice. The T.I.M.E. concept, was first published in 2003 and has been a great help in structuring the concepts of local therapy. However, in the last 15 years many new aspects and treatment options have emerged, which are not represented in the T.I.M.E. concept. Therefore it was the aim of our interdisciplinary and professionally diverse expert group to develop the proven T.I.M.E. concept for the systematic local therapy of chronic wounds in order to include current options – this results in M.O.I.S.T.
M.O.I.S.T. is an acronym, each initial letter stands for one of the treatment options that are summarized in the new concept. Is the acronym M.O.I.S.T. also a reference to the "moist wound therapy", which is a standard in wound care for about 50 years?
The study by the British physician Dr. George D. Winter marks the beginning of the so called "modern wound care". He was able to show impressively how wounds heal faster in a moist wound environment. The data led to a paradigm shift in wound care. In this respect, the acronym M.O.I.S.T. fits very well to the basic concepts of moist wound therapy.
The factors "T" (tissue management), "I" (infection control) and "M" (exudate management) from the original T.I.M.E. concept remain in the new M.O.I.S.T. concept. Why are these factors indispensable in wound healing?
The factors "T", "I" and "M" of the T.I.M.E. concept are still important and therefore belong to the modern wound care. There are many scientific investigations underlining their central and significantly importance. These points have therefore been just slightly modified in the M.O.I.S.T. concept.
In the T.I.M.E. concept the letter "E" stands for "epidermis" or "edge" according to wound margin. Why is this factor missing in the new M.O.I.S.T. concept?
The letter "E" describes very different concepts like debridement, skin transplants and biological wound therapeutics, which prepare or support a re-epithelialization. These aspects are still very important, but they are more clearly differentiated in the M.O.I.S.T. concept.
In recent decades, many new aspects and treatment options have emerged. The new M.O.I.S.T. concept was therefore supplemented by "O" (Oxygen) and "S" (Support). What makes these factors so important that they could influence the development of a new therapy concept?
For our expert group, the letters "O" for "Oxygen" and "S" for "Support" help to differentiate and include current, purposive therapy options. This is especially for the so-called stagnant or refractory wounds of great practical importance.
Should the five factors of M.O.I.S.T. be used by themselves or is the interaction of these factors of certain importance?
To ensure a successful wound therapy as many of these aspects as possible should be considered in the treatment of chronic wounds. In this respect, a structured interplay of these factors is essential.
How easily can the five treatment options of M.O.I.S.T be included in the daily wound management?
The M.O.I.S.T. concept takes the relevant aspects of daily wound management into account. It represents a structuring of what is actually applied in many relevant centers. I am sure that wound care experts can easily integrate this concept, because most of them have already worked like this or in a similar way during the last few years.
You are a senior physician of dermatology at the University Hospital in Essen. Furthermore, you are on the board of the Wund-D.A.CH and the ICW e.V. Can you tell from your personal experience how strongly M.O.I.S.T. is already practiced?
After the first publication in the JDDG in April this year and presentations at various congresses, such as the German Wundkongress 2017 in May with almost 5,000 participants, the response was overwhelming. With the support of expert associations, this concept is now increasingly accepted as a treatment standard in the German-speaking countries and as the basis for appropriate training courses. In this respect, it will certainly take some time until the M.O.I.S.T. concept will comprehensively be adopted.
You said yourself that the presentation of M.O.I.S.T. especially at the German Wundkongress was very successful. Have you already planned further measures to increase the prominence of M.O.I.S.T.?
The M.O.I.S.T. concept has already been published in numerous publications and further publications will follow in the next months. This includes standard teaching books, such as Braun Falco's dermatology, in which the M.O.I.S.T. concept is introduce as the standard local therapy for chronic wounds. Furthermore, M.O.I.S.T. will be presented on the Wund-D.A.CH congress “Dreiländerkongress für Wundbehandlung” at the end of September 2017 in St. Gallen, Swiss. This all will help M.O.I.S.T. to increasingly become the standard for wound therapy of chronic wounds in scientific studies.
1 Members of the expert group: Joachim Dissemond, Bernd Assenheimer, Peter Engels, Veronika Gerber, Knut Kröger, Peter Kurz, Severin Läuchli, Sebastian Probst, Kerstin Protz, Jürg Traber, Siegfried Uttenweiler, and Robert Strohal.