Correct wound care concept

There is never a "one size fits all" standard answer to correct wound care. The core essence is to choose a care method that matches the current status of the wound while fully controlling the risk of infection, and giving priority to providing a suitable environment for tissue repair, rather than blindly pursuing "dry scabs" or "full wet dressing".

Every time I say this to patients in the outpatient clinic, eight out of ten people's first reaction is "Huh? My mother told me since I was a child that wounds should be left to dry to heal quickly, right?" Last week I just treated a little girl who is a sophomore in high school. She fell on her knee while riding a shared bicycle and lost a large piece of skin. When she got home, her grandma refused to let her carry the bag, saying that it would easily rot if she held it, so she left it to dry and developed a thick scab. As a result, it started to hurt on the third day and she limped when she walked. When the scab was removed, there was yellow-white pus all down there. The little girl was so painful that she burst into tears. It made me feel bad to see her.

In fact, we cannot blame the older generation for having wrong ideas. In the early years, medical conditions were poor and there were no specialized wet dressings. The wounds were exposed to an environment full of dust and bacteria. Dry scabs can at least block some foreign pathogenic bacteria. This idea of ​​"dry healing" was confirmed in the era of scarcity of supplies. It has actually saved many people. Until now, for extremely superficial wounds with almost no exudation - such as the skin on the back of the hand that is not broken by a little oil, or a small cut torn by a barb on the edge of a fingernail - as long as it is disinfected and not touched with dirt, it can be completely cured by leaving it to dry. There is no need to go overboard and apply a dressing.

But in 1962, British zoologist Winter confirmed through experiments that "the crawling speed of epidermal cells in a moist environment is twice that of a dry environment, and the healing speed can be increased by more than 50%." The concept of wet healing has long become the mainstream consensus in clinical care. However, many people have misunderstood it, thinking that the wound should be soaked in water or kept covered. In fact, it is not at all.

To put it bluntly, you have to look at how much water the wound drains. If there is a lot of exudate in the first two or three days after the injury, you have to use a dressing that can absorb the exudate, such as a foam dressing or sterile gauze. Change it when the exudate is full. Don't let the water soak in the wound. After a few days, the exudate will decrease and the wound will start to grow tender flesh. Just switch to a hydrocolloid with better airtightness to lock in the humidity so that epidermal cells can crawl smoothly. If you leave it dry at this time, the wound will form a hard scab and the epidermal cells will not be able to crawl. You will have to wait for the scab to fall off on its own. Not only will it heal slowly, but it will also leave scars easily.

There is also a misunderstanding that many people make, that is, the more frequent the disinfection, the better. Rub alcohol and iodine on the wound. Last month, a brother who ran a marathon had a big blister on the sole of his foot. After pricking it, he used alcohol to disinfect it three times a day. The wound was still not healed after a week, and the surrounding skin was irritated and turned white and peeled off. When he came, he asked me, "Why can't it be bad if I disinfect so frequently?" Think about it, the new granulation tissue in the wound is as tender as freshly sprouted bean sprouts. When a highly irritating disinfectant like alcohol and iodine is poured in, the new cells will be burned to death. Is it surprising that the wound heals quickly? The correct approach is to rinse the wound with saline or alcohol-free iodophor. Only the intact skin around the wound can be disinfected with alcohol. Do not touch the wound surface.

There is also the question that everyone is most concerned about: "Can it touch the water?" There is no standard answer to this. If you have sealed the wound with a sterile dressing, it is perfectly fine to take a shower and put on a new dressing immediately after washing. It is better than not taking a shower for ten days and a half, and the oil and bacteria on the surrounding skin will penetrate through the gaps in the dressing. If the wound has grown a thin layer of new epidermis, it will not hurt to the touch. It is perfectly fine to touch clean water at normal temperature. There is no need to feel like you are facing an enemy when touching water.

Speaking of which, I cut my left index finger last year when I was cutting vegetables. The incision was quite deep and it bled for almost ten minutes. I rinsed the minced meat with saline at home, wiped the surrounding skin with iodine, and put a hydrocolloid dressing on it. I changed it every three days. It was completely healed in less than a week. Now the scar is almost invisible. If I had left it to dry as my mother said, it would have hurt for at least half a month, and left a dark brown mark that would not go away for more than half a year.

In fact, there is really no "absolutely correct" nursing formula. Don't listen to people on the Internet who say that wet healing is necessary, so just stick a hydrocolloid on any wound and let it sit. Don't stick to the old idea of leaving any wound to dry. If you are really not sure, go to the community hospital near your home and see a nurse for a look. It only costs a few dollars. It is better than messing around on your own, turning a small wound into a chronic ulcer, leaving scars or even having to debridement, right?