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Wound management: Appropriate approaches minor wounds

Skin Conditions, General | February 9, 2015 | Author: The Super Pharmacist

skin, general

Wound management: Appropriate approaches minor wounds

A wound is any break in the skin, regardless of cause. The body has an amazing ability to heal itself, and most minor wounds will repair themselves within several days. Larger wounds will eventually heal, but they usually require additional help such as sutures, ointments, and dressings. Very large wounds may require advanced interventions such as skin grafts, hyperbaric oxygen therapy, and negative pressure wound therapy. Serious wound should always be evaluated and treated by a physician, but many people can effectively manage their own minor wounds until they completely heal.

The healing process and wound management

The process of wound healing is extremely complex and requires the orchestration of many different biological processes. In healthy individuals, the wound will heal if the following conditions are met:

  1. All areas of the wound have an adequate blood supply
  2. All dead or dying tissue has been removed
  3. No infection is present
  4. The wound is kept hydrated (but not too wet)

1. Ensuring adequate blood supply

In healthy individuals with good blood circulation, wound management should ensure adequate blood supply. Even areas that have blood clots will still have a decent blood supply immediately after the injury, and new blood vessels will be formed in the area shortly thereafter.

2. Wound debridement

The second criteria may require a process called wound debridement. Dead or dying tissue is removed from the area during wound debridement.

For minor injuries, this may require nothing more than simple irrigation or washing the wound with water. While hospitals will use sterile saline for irrigation, studies have shown that tap water irrigation does not significantly increase the rate of wound infection.

Surgical debridement may be required if there are large areas of dead tissue, for example, after serious burns. In surgical debridement, dead tissue is cut away from healthy tissue in the wound. Surgical debridement may also be necessary if infection has been present in the wound.

Several enzymatic debridement products such as collagenase, papain, and bromolain creams are commercially available. While these products may dissolve areas of dead or dying tissue (though they may not), these enzymes should be used only when supervised by medical professional.  In actuality, most minor wounds will not need debridement beyond simple irrigation.

3. Preventing infection

Perhaps surprisingly, antibiotics are not necessarily useful for every wound. In fact, the current standard practice is to not use oral antibiotics unless the wound shows signs of infection. Signs of wound infection include:

  • Pus in or around the wound
  • An odd or bad smell from the wound
  • The skin around the wound is red, swollen, warm, and tender to the touch (i.e. cellulitis)
  • Red streaks appear on the skin traveling toward the heart
  • The wounded person has fever, chills, nausea

Most topical antibiotics or antiseptics may actually interfere with wound healing. While they may kill bacteria, they may also destroy new cells. In most cases, these topical agents should be avoided. Two topical medications may be possible exceptions to this guideline. Cadexomer iodine (Iodosorb) potently kills many forms of bacteria and may stimulate healing by keeping the wound moist. In cases of obvious surface infection, silver-containing dressings may assist to treat the infection; however, clinical studies of silver-containing dressings have failed to show that they benefit wound healing despite being widely used by physicians and surgeons.

4. The ideal wound dressing

The ideal wound dressingKeeping a wound moist is as important to rapid and successful wound healing as any of the other items mentioned.

Wounds that are kept moist heal 40% faster than wounds that are left exposed to the air. Wounds that are kept covered are less likely to yield noticeable scars. 

Despite large numbers of commercially available bandages, there is little research to support the use of one type of dressing or bandage over another. Nevertheless, the qualities of the ideal dressing are straightforward. The ideal dressing:

  • Keeps a wound moist while absorbing excess fluid
  • Deters bacteria from entering the wound
  • Prevents further damage at the site
  • Needs to be changed infrequently (no more than once per day)
  • Can be changed with little pain or tissue damage
  • Does not allow space between the dressing and the wound, but does not overly compress tissues that are trying to heal, either
  • Is relatively inexpensive and transparent so that wound healing can be assessed without removing it

Unfortunately, no single dressing possesses all of these qualities. Therefore, the user must decide which of the features will be the most important when treating a specific wound.

Which wound dressing is right for you?

To reiterate, the highest priority is to keep the wound moist without excess wetness. One way to classify wound dressings is by their ability to retain moisture, namely open, semi-open, or semi-occlusive.

Open dressings like dry gauze are no longer used as primary wound dressings, at least without another layer between the gauze and the wound. In other words, dry gauze can be used to secure another dressing in place, but they should not be used directly on a wound.

This is because dry gauze tends to dry out the wound and dressing changes are not only painful, but they destroy new healing tissue as it is trying to form. 

One possible exception is if the wound is producing copious amounts of fluid and other dressings are not adequately absorbing it. If this is happeneing, make sure the wound is not infected (i.e. is that fluid actually pus?).

Semi-open dressings are similar to gauze except they contain substances that keep them moist, such as petroleum jelly or various ointments. Even with these substances, however, wounds tend to dry out too quickly while at the same time other areas of the wound may become too wet. Semi-open dressings also need frequent changing.

The type of dressing that comes closest to the ideal is a semi-occlusive dressing. Even within this one category, there are many dressing types. Semi-occlusive dressings include

  • Alginates
  • Films
  • Foams
  • Hydrocolloids
  • Hydrogels
  • Hydroactives

Any of the dressings listed above should keep wounds sufficiently moist to promote wound healing. On the other hand, semi-occlusive dressings are limited by their ability to absorb excess fluid that the wound may produce (i.e. exudate).

Complications: People with chronic illnesses

Wound healing can be delayed in people with certain health conditions. For instance, people with poor blood circulation may find that it takes a long time for wounds to heal because the wound does not have an adequate blood supply. Sadly, one of the complications of diabetes is poor wound healing. This may be due to increased susceptibility to infections and poor circulation. People with chronic health conditions may require a wound specialist to help select the proper wound dressing and management techniques.  Australia’s best online discount chemist


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