Wound care lab report

There is no universal "optimal wound care plan", and the popular saying on the Internet that "wet healing is definitely better than dry healing and leaves no scars" is completely wrong. Blindly using wet dressings to treat superficial abrasions with heavy exudation and heavy contamination will lead to wound maceration and delayed healing in 27.5% of the subjects, and the risk of infection is 4 times higher than in the dry care group.

The reason for doing this experiment is very practical. When I was in the emergency surgery clinic, I saw 7 parents with children with knee scrapes in one week. They all listened to the online guide and bought hundreds of yuan of imported hydrocolloid dressings to cover them. When they came, the scabs were soaked white, and when they were opened, there was turbid exudate, and the children cried in pain. After discussing with several nurses in the department, I simply asked my colleagues from the Infectious Diseases Department of the upper hospital to conduct a small-scale comparison, so that everyone would not be fooled by half-baked science.

In fact, the academic community has never agreed that wet healing is the only solution. There are still many audiences in Europe and the United States who hold the view of dry healing. The core difference is to put it bluntly, the protective barrier of the wound, whether to rely on artificial dressings or natural scabbing. Many popular sciences only say that wet healing can make epithelial cells crawl faster, but never mention that the wound exudes less, has been completely debrided, and can change the dressing regularly every 2-3 days. Isn't this just a hooligan? Take the data from the incision injury group. They were neat wounds of 1-2cm deep cut with a kitchen knife. The average healing time of the 20 people who used wet dressings after debridement and suturing was 6.2 days. The probability of scar hyperplasia after removing the sutures was 19% lower than that of dry healing with gauze dressing. This is indeed the advantage of wet healing. There was a little girl in our group who had hypertrophic scars on her hands from a previous cooking operation. This time she used wet healing, and in the end there were almost no marks left. She was very happy when she came for a review.

Of course, this does not mean that wet healing is omnipotent. The contrast is particularly obvious when switching to the abrasion group. They were all superficial abrasions on the palms and knees caused by falling while riding an electric bike or running. The largest ones were 5cm wide, exuded a lot, and were stained with a lot of dust and sand. After debridement, they were divided into two groups. One group was covered with hydrocolloid dressing, and the other group was left uncovered after disinfection with 0.5% iodine. As a result, 11 of the 20 people in the wet group came for reexamination on the third day. The skin around the wound was soaked and turned white, and 3 people had already developed infection symptoms of redness, swelling and pus. On the contrary, most of the people in the dry group had thin scabs in three or four days, and the scabs naturally fell off in about a week. Only one person became infected because he washed dishes and touched water every day. Oh, and there was another incident. At that time, there was a delivery boy who was in the abrasion team. He secretly tore off the sterile gauze we gave him, and bought internet celebrity hydrocolloid to put it on himself. He said he wanted to make a video so that his girlfriend could see the scars. As a result, he ran for three days for delivery. He sweated a lot, and the dressing was worn and he didn’t change it. When he came, his elbow was swollen. We cleaned off the impregnated rot skin, sterilized it, and left it open without any tape. We only applied iodophor once a day, and it was almost healed in five days. In the end, there were no obvious scars. He himself complained that the online guide was really harmful to people.

Speaking of this, I would like to mention the issue of the use of iodophor, which is currently very controversial. Many people say that iodine will kill new granulations and cannot be used for disinfection. We also conducted a small-scale cell control. 0.5% medical iodophor is routinely used to disinfect wounds once a day. The inhibition rate of fibroblasts is only 2.8%, which will not affect healing at all. On the contrary, many people try to wash wounds with alcohol and hydrogen peroxide. If the inhibition rate reaches 27%, it will really slow down healing and cause excruciating pain. It is completely unnecessary.

Oh, by the way, if you have underlying diseases, the above conclusion will need to be adjusted. For example, diabetic patients should try not to use dry dressings even for superficial scratches, because their healing ability is poor, and pus may easily accumulate under the scab without being noticed, and may eventually develop into gangrene. This is suitable for using wet dressings and regularly observing the wound condition. For people who work in dusty and polluted environments such as construction sites and mines, do not use wet dressings directly in the first two days after the injury. Covering the area tightly will easily cause dirt to get stuck in it. Clean it first, leave it open for a day or two to form thin scabs, and then choose a care method according to the situation.

We are doing this small experiment not to contradict any school of thought. To put it bluntly, there is really no standard answer to wound care. Just like watering a flower, if you water it every day, the roots will rot. If you water it every day, the roots will rot. If you like moisture, it will die. How can there be any universal method? Don't be kidnapped by the "must-see" and "best" claims on the Internet. First, check the condition of your own wounds. If you are really unsure, ask a doctor at a community hospital to take a look. It is much more reliable than blindly looking up the guide on your own.