Wound Care Introduction

A wound is a break in the skin (the outer layer of skin is called the epidermis). Wounds are usually caused by cuts or scrapes. Different kinds of wounds may be treated differently from one another, depending upon how they happened and how serious they are. Healing is a response to the injury that sets into motion a sequence of events. With the exception of bone, all tissues heal with some scarring. The object of proper care is to minimize the possibility of infection and scarring. There are basically 4 phases to the healing process: Inflammatory phase: The inflammatory phase begins with the injury itself. Here you have bleeding, immediate narrowing of the blood vessels, clot formation, and release of various chemical substances into the wound that will begin the healing process. Specialized cells clear the wound of debris over the course of several days. Proliferative phase: Next is the proliferative phase in which a matrix or latticework of cells forms. On this matrix, new skin cells and blood vessels will form. It is the new small blood vessels (known as capillaries) that give a healing wound its pink or purple-red appearance. These new blood vessels will supply the rebuilding cells with oxygen and nutrients to sustain the growth of the new cells and support the production of proteins (primarily collagen). The collagen acts as the framework upon which the new tissues build. Collagen is the dominant substance in the final scar. Remodeling phase: This begins after 2-3 weeks. The framework (collagen) becomes more organized making the tissue stronger. The blood vesseldensity becomes less, and the wound begins to lose its pinkish color. Over the course of 6 months, the area increases in strength, eventually reaching 70% of the strength of uninjured skin. Epithelialization: This is the process of laying down new skin, or epithelial, cells. The skin forms a protective barrier between the outer environment and the body. Its primary purpose is to protect against excessive water loss andbacteria. Reconstruction of this layer begins within a few hours of the injury and is complete within 24-48 hours in a clean, sutured (stitched) wound. Open wounds may take 7-10 days because the inflammatory process is prolonged, which contributes to scarring. Scarring occurs when the injury extends beyond the deep layer of the skin (into the dermis).

Wound Care Signs and Symptoms

Scrapes and abrasions are superficial (on the surface). The deeper skin layers are intact, and bleeding is more of a slow ooze. They are usually caused by friction or rubbing against an abrasive surface. Lacerations (cuts) go through all layers of the skin and into the fat or deeper tissues. Bleeding may be more brisk or severe. Severe blows by a blunt object, falls against a hard surface, or contact with a sharp object are the most common causes of lacerations.

 Puncture wounds are generally caused by a sharp pointed object entering the skin. Most common examples are stepping on anail, getting stuck with a needle or a tack, or being stabbed with a knife. Bleeding is usually minimal, and the wound may be barely noticeable. Human bites and animal bites can be puncture wounds, lacerations, or a combination of both. These wounds are always contaminated by saliva and require extra care.

Home Care
Scrapes and abrasions often do not require any more care than washing the area 4 times daily for the first 48 hours and keeping the area covered with a sterile bandage. Deeper wounds and bites will require medical attention. Stop the bleeding: If bleeding will not stop, apply a clean bandage to the area and press down on it for 10 minutes. Clean the wound: Water under pressure is the best way to clean a wound. Either a briskly running faucet or a hand-held shower nozzle is the best way to wash a wound. The wound should be washed for 10-15 minutes. Make sure you remove all dirt and debris. Do not scrub deep wounds or bites, just wash them out. Check when you last had a tetanus shot.

Wound Care Treatment

After careful examination and evaluation, the wound will once again be cleaned.

The area will then be numbed with a localanesthetic. This will allow a deeper examination of the wound as well as repair without any further discomfort. You may feel pressure, but no pain. If the wound requires stitches, it will be cleansed with an antiseptic solution, and sterile towels or drapes placed over the area. o together. The doctor will wear sterile gloves and put in the stitches to bring the wound edges

o Once this has been accomplished, the area will be washed off once again and a sterile bandage applied. You will be given further instructions regarding care of the wound. o Generally the bandage is kept on for 2 days. You should keep it clean and dry, elevating it whenever possible to minimize swelling and pain. o Over-the-counter pain relievers such as acetaminophen (Tylenol) oribuprofen (Motrin) are usually sufficient for any pain.

o You will be told when the stitches need to be removed. Once they are removed, small tapes may be applied over the wound to lessen the stresson the healing wound and to lower the amount of scarring, especially if on the face. o Use a sunblock (not a sunscreen) on the area for 6 months to avoid discoloration from sun exposure. Bites may not be sutured unless a large area is involved or the bite involves the face. Many of these become infected, so most doctors prefer to leave them open for daily wound care. You usually will be given antibiotics for bite wounds. Abrasions will be washed and scrubbed, if needed. It is important that all the dirt and debris be removed because tattooing (permanent skin discoloration) may result if this debris is left in the wound. Puncture wounds will require careful examination. If there is any dirt or debris in the wound, the doctor may remove this small area so that an infection does not occur.

Post-surgical wound care

Taking care of your wound

Your dressing should remain in place until the day after the procedure. If the dressing comes loose before then, replace it carefully. Cleanse the wound or suture line twice daily with soap and water. Use a cotton-tipped swab (Q-tip) to remove any dried blood or crust. Pat dry gently. Apply a thin layer of Bacitracin or Polysporin ointment over the wound and cover with a new Telfa pad (non-stick dressing) or bandage. Avoid using ointments containing neomycin (Neosporin) because they may cause redness or itching in some people. The first day the wound may be tender and bleed slightly or seep a small amount of clear fluid. Two days after surgery you may shower and allow the wound to get wet, but do not let the forceful stream of the shower hit the wound directly. Always remove a wet bandage promptly and replace with a dry bandage applied over a layer of antibiotic ointment.

What to expect

For the first day or two, do not move the affected area too much in order to avoid causing bleeding. The pressure of the bandage should help to prevent bleeding but a small amount of blood on the dressing is normal. If bleeding seems persistent, apply pressure firmly and steadily over the dressing for 10 to 15 minutes. This will usually stop the bleeding but if it does not, call our office promptly. In addition, there may be swelling and bruising around the wound, especially if your face or the area around your eyes was treated. To minimize this, the day after surgery you may apply an ice pack over the dressing every 2 to 3 hours for 10 to 15 minutes. The wound may feel numb for up to several weeks, but this almost always resolves with time. After surgery, the suture line and wound edges will appear pink to red in color but the area will lighten every day. Once the sutures are removed, the incision line and suture marks will continue to fade over weeks to months. In rare instances, a wound may heal with a thickened scar. This usually occurs in patients with a prior history of poor healing but is also dependent upon the location of your incision. If you develop a fever or chills or the wound becomes increasingly inflamed, warm, or contains pus, please call our office.

Managing pain

Post-operative pain is usually minimal. Take 2 tablets of Extra-Strength Tylenol every 4 hours as needed. Your physician can prescribe a stronger pain medication should you require it. Do not take products containing aspirin or ibuprofen because these may increase bleeding. An ice pack can lessen pain as well. Post-operative pain usually resolves within the first week following surgery but you may experience discomfort in and around the wound as it heals over the next several weeks