General Wound Care

Types of Wounds There are 2 main types of wounds:

1. AN ACUTE WOUND
is a clean cut wound closed by sutures or staples, e.g. after surgery or a laceration.

2. A CHRONIC WOUND
is an open wound extending into at least the second layer of the skin called the dermis (See Figure - Layers of Skin) that needs to be filled with new tissue, e.g. an ulcer or pressure sore. These wounds may experience delayed healing and may be involved complex wound care.
Figure 1 Layers of the Skin

Phases of Wound Healing

Phase 1 - INFLAMMATORY PHASE (0-3 Days) This is your bodys normal response to injury. This phase activates protective measures through chemical activity causing HEAT, REDNESS, PAIN, SWELLING, LOSS OF FUNCTION (e.g. arm swells and cannot bend). Wound ooze may be present and this is also a normal body response. Phase 2 - PROLIFERATIVE PHASE (3-24 Days) This is the time when your wound is healing. Your body makes new blood vessels, which cover the surface of the wound. The result is that your wound will become smaller as it heals. Phase 3 - MATURATION PHASE (24-365 Days) This is the final phase of healing, when scar tissue is formed.

Stitches, Clips or Staple Removal

Normally stitches, clips or staples are removed within approximately 10 days of the surgical procedure unless otherwise advised by your health professional. Prior to your discharge from hospital your health professional should advise you as to when they would like your stitches, clips or staples removed and arrange for their care or removal by one of the services highlighted over.

Before you Leave the Hospital

Medical, Nursing and Allied Health professionals will discuss with you and/or your carer any concerns or needs you have about caring for your wound. If you have any questions ask the medical, nursing or allied health professionals before you are discharged from hospital. On discharge from the Hospital/Health Care Service you will either: 1. Attend to your own wound care under the supervision of your GP or 2. Be referred to a specialist clinic (e.g. Leg Ulcer or Burns & Plastics, Hand Therapy or Podiatry) or 3. Be referred to the Hospitals Acute Care/Post Acute Service or 4. Be referred to a Community Service (e.g. Community Nursing Service) where the community nurses will be managing the wound in consultation with the GP, specialist or a Nurse Practitioner. You may have an interview prior to your discharge with the Nurse Discharge Co-ordinator if you are discharged to APAC or Community Nursing Services. When you leave hospital you will be given a copy of your discharge summary to take to your local doctor. A photocopy of your wound assessment, treatment & evaluation plan may also be attached to your discharge summary.

Looking after your Wound at Home

How should the wound be cleaned at home?
1. Always wash your hands with liquid soap and dry with paper towels or a clean towel before touching your wound or dressing. This helps to reduce the risk of infection. NB. If the dressing is difficult to remove, allow the water to soak the dressing off to avoid damaging the wound. 2. Clean your wound by running warm shower water at moderate pressure directly over the wound for a few minutes. This will be sufficient to cleanse the wound. 3. You must ensure that the water used for washing wounds should be 'drinkable' quality. 4. Allow the shower to gently remove debris from the wound. Avoid letting the soap enter the wound. 5. Gently pat dry the skin around your wound with a clean towel but do not touch the wound itself. 6. Avoid touching the wound. However if you do touch the wound or dressing wash your hands again with liquid soap and dry with paper towels or a clean towel to reduce the risk of infection. 7. Ask your GP, nurse or allied health professional if you have any questions.

WHAT DRESSING DO I NEED?

1. Different types of dressings are used for different wounds. 2. Therefore your doctor, nurse or allied health professional will inform you about the type of dressing and the amount of dressing best suited to your wound. 3. After showering apply your dressing or immediately cover with a temporary dressing or a clean pad unless you have been instructed to leave the wound open. 4. The dressing helps the wound to stay moist and heal more quickly. However if the skin around the wound becomes too moist the healing may be slowed. Signs of a wound that is too moist include white wound edges that are soft and fragile. Contact your health professional if this occurs.

HOW LONG SHOULD THE DRESSING STAY IN PLACE?

Generally speaking most wounds heal quicker if the dressings are changed only each 3-7 days. If the wound is leaking large amounts of ooze, the dressing will need to be changed more often. If you have a venous ulcer and have been instructed to wear a compression stocking, please ensure that you wear it as it will play a crucial role towards your wound healing.

Will my Diet Affect the Wound Healing Process?

Good nutrition is important and can help to decrease the time it takes for your wound to heal. This is because wounds require large amounts of energy, protein, vitamins and minerals to heal properly.

Healthy Eating
dequate energy and protein are essential in wound healing. A However healthy eating also involves eating a balanced diet containing foods from all food groups. Without foods from each food group you may not be getting enough of all the nutrients, like vitamin A, C and E, zinc and iron to promote wound healing.

EAT IN SMALL AMOUNTS

Foods high in fats margarine, butter, oil, cream, dips, pastries, cakes and biscuits, chocolates, fried foods, instant noodles, chips. Foods high in sugar lollies, soft drinks, cordial, sugar, jams, honey, syrup, chocolate. Alcohol Salt

EAT MODERATELY
Dairy foods milk, cheese, yoghurt, custard, ice cream (choose low fat varieties) Eggs Nuts Meat, chicken, fish (choose lean cuts, chicken without the skin. Include canned fish)

EAT MOST
Breads and cereals bread, bread rolls, breakfast cereals, crumpets, muffins, oats. Pasta noodles, spaghetti Rice Fruits & vegetables fresh, frozen, canned (not in syrup), juices (no added sugar) Legumes dried peas, beans, lentils, baked beans.

Energy
You may not be eating enough energy for your wound to heal if you: Have a poor appetite Often skip meals Often become nauseous Are eating poorly Are underweight or losing weight without trying If you are not eating well, try to eat small amounts regularly and avoid skipping meals. Your dietitian can provide advice about appetite and nutritional supplements and should be contacted if your appetite is poor or you are losing weight.

Protein
Your body uses protein from foods that you eat to maintain muscles and heal wounds. The bodys requirements for protein are increased when you have a wound or pressure ulcers. Good sources of protein include red meat, chicken, fish, eggs, milk, yoghurt, cheese, nuts, legumes and tofu. You should check with your Doctor or Dietician before starting a high protein diet and seek advice if you follow a vegetarian or vegan diet.

Diabetes
If you have diabetes, good blood glucose control will help your wound heal faster.

Supplements
Sometimes your requirements for some nutrients become very high while your wound is healing. If you are eating poorly or your wound is not healing, talk to a Dietitian about if specialised wound healing supplements may help.

Fluid
The body requires at least 1.52 litres (68 cups) of fluid per day unless otherwise instructed by your doctor or health professional. Sources of fluid include water, milk, juice or cordial, decaffeinated coffee, soups, custards, jelly etc. Good nutrition is important and can help to decrease the time it takes for your wound to heal. This is because wounds require large amounts of energy, protein, vitamins and minerals to heal properly.

MEDICATIONS
Many medications, especially steroids and drugs that have anything to do with the inflammatory response, can delay or slow the healing process of the wound. Ask your doctor, nurse or pharmacist for further information if required. Don't stop taking medications without consultation with your Health Professional.

Should I Exercise?
In some instances surgical wounds may require you to refrain from lifting, mobilising or moving your limb. Low impact exercise will increase venous return and blood flow to the skin and is encouraged. Regular 10-15 minute slow walking regimes are beneficial, especially for venous and arterial ulcers. Smoking is detrimental to your health and to the wound healing process. Can we help you give up smoking?

Experiencing an Increase in Pain

An increase in pain or discomfort should not be ignored. You should discuss the symptoms of your pain with your Health Professional.

Infected Wound
An infected wound must be treated promptly and may require antibiotic therapy. An infected wound will take longer to heal. Early treatment of an infected wound will increase the chances of the wound healing as quickly as possible. COMMON SIGNS OF WOUND INFECTION FEVER INCREASED SWELLING PUS INCREASED REDNESS INCREASED PAIN OFFENSIVE ODOUR

How Should the Wound be Cleaned when my Wound is Infected?

Your wound can be cleaned by running warm shower water at moderate pressure directly over the wound for a few minutes.

What Dressing do I Need when my Wound is Infected?

Specialised dressings may be recommended when your wound is infected. The aim of these dressings is to remove the infected material, by absorbing it into a dressing away from the wound. The infected wound will require the use of specialist medicated dressing, or more frequent dressing to be changes if the wound is leaking fluid.

How Long should the Dressing Stay in Place when my Wound is Infected?
Your health professional or nurse will inform you about the type of dressing and the amount of dressing changes that will be best suited for your wound.

What Medications will I Need when my Wound is Infected?

Some infections will need to be treated with Antibiotics. Your Doctor will decide if antibiotic therapy will be used.
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What Should I do if I Experience Complications?

If you experience any of the following symptoms, contact the Wound Clinic, your General Practitioner or Hospital Emergency Department: Prolonged burning Fever Excessive drainage from the wound Increased pain Any concerns about your health

How do I Care for my Wound after it has Healed?

Remember the healed area is fragile and should be treated gently Treat any minor abrasions promptly Use a moisturising cream to keep your skin moist once your wound is healed Keep the healed wound away from direct sunlight as new skin is very fragile If you have any concerns, discuss with your doctor This guide has been designed to inform you of ways that you may contribute to your health and enhance your knowledge about important areas promoting a better chance for your wound to heal in a timely fashion. It should be noted that this guide contains general information. If a health professional has given you specific instructions that are different to this information, you should follow the instructions you have been given.

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For further information about this guide or your wound care, do not hesitate to call your GP.
Alternatively, contact the most appropriate service within NSCCAHS on: Ph: 

We wish to gratefully acknowledge the Gold Coast Health Service & Townsville Health Services for the information contained in this booklet. Disclaimer: This tool is intended as a guideline only. Each patient is an individual and responses may vary. If you have any questions please talk to your Doctor, Nurse or Allied Health Professional.

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CATALOGUE NO: 09702