Wound Care

Blood helps clean wounds, so a little bleeding is good. Most small cuts and scrapes stop bleeding pretty quickly, but you can help by applying firm, gentle pressure with gauze or a tissue. If blood soaks through, put another piece of gauze or tissue on top, don't remove the old one or you may separate the wound and start the bleeding again.

Ouch! Got another cut or scrape? Your first step is easy: Soothe and clean the wound with cool water. Then remove any pebbles or splinters with alcohol-sterilized tweezers. Gently wash around the wound with soap and a washcloth. Do not use irritating soap, iodine, alcohol, or hydrogen peroxide -- fresh, clean water should be all you need.

Wound Care

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Antibiotic creams and ointments not only keep wounds moist but they can reduce the risks of infection. If you do use an antibiotic, apply a thin layer on the wound. Certain antibiotic ingredients can trigger a rash in some people. If you get a rash, stop using that ointment.

Almost as soon as you get a cut or scrape, your body begins healing the injury. White blood cells attack infection-causing bacteria. Platelets, red blood cells, and fibrin create a jelly-like clot over the wound and soon a protective scab forms. If your wound gets itchy, be gentle -- you want that scab to stay where it is.

Taking care of a surgical wound is similar to taking care of cuts and scrapes. You'll probably have to protect the incision with a bandage for a few days, and change the dressing daily. Follow your doctor's instructions for taking care of stitches or staples. You'll also want to keep the area dry, and report any increase in bleeding or redness to your doctor.

If there's skin redness that spreads out from your injury, swelling, green or yellow fluid, or increased warmth or tenderness around the wound, you may have an infection. Other signs include swollen lymph nodes at your neck, armpit, or groin, as well as body aches, chills, or fever. If you have any of these signs, give your doctor a call.

The appearance of a scar often depends on how well the wound heals. While scars from surgery or over joints like the knees and elbows are hard to avoid, scars caused by minor cuts and scrapes can become less noticeable by properly treating the wound at home.

To help the injured skin heal, use petroleum jelly to keep the wound moist. Petroleum jelly prevents the wound from drying out and forming a scab; wounds with scabs take longer to heal. This will also help prevent a scar from getting too large, deep or itchy. As long as the wound is cleaned daily, it is not necessary to use anti-bacterial ointments.

After cleaning the wound and applying petroleum jelly or a similar ointment, cover the skin with an adhesive bandage. For large scrapes, sores, burns or persistent redness, it may be helpful to use hydrogel or silicone gel sheets.

Change your bandage daily to keep the wound clean while it heals. If you have skin that is sensitive to adhesives, try a non-adhesive gauze pad with paper tape. If using silicone gel or hydrogel sheets, follow the instructions on the package for changing the sheets.

Apply sunscreen to the wound after it has healed. Sun protection may help reduce red or brown discoloration and help the scar fade faster. Always use a broad-spectrum sunscreen with an SPF of 30 or higher and reapply frequently.

If you have minor cuts or scrapes, you can help reduce the appearance of a scar by properly treating the injury at home. However, if your injury is deep, very painful or if your skin becomes infected, seek immediate medical care.

processing.... Drugs & Diseases > Clinical Procedures Wound Care Treatment & Management Updated: Apr 24, 2020 Author: Brian J Daley, MD, MBA, FACS, FCCP, CNSC; Chief Editor: Zubin J Panthaki, MD, CM, FACS, FRCSC more... Share Print Feedback Close Facebook Twitter LinkedIn WhatsApp Email webmd.ads2.defineAd({id: 'ads-pos-421-sfp',pos: 421}); Sections Wound Care Sections Wound Care Overview Background Epidemiology Etiology Pathophysiology Indications Relevant Anatomy Prognosis Show All Presentation Physical Examination Complications Show All Workup Laboratory Studies Imaging Studies Diagnostic Procedures Show All Treatment Medical Care Surgical Care Future and Controversies Show All Questions & Answers Media Gallery Tables References Treatment Medical Care General treatment of nonhealing wounds Assess the entire patient

Successful treatment of difficult wounds requires assessment of the entire patient and not just the wound. Systemic problems often impair wound healing; conversely, nonhealing wounds may herald systemic pathology.

Inadequate protein-calorie nutrition, even after just a few days of starvation, can impair normal wound-healing mechanisms. For healthy adults, daily nutritional requirements are approximately 1.25-1.5 g of protein per kilogram of body weight and 25-30 calories/kg. These requirements can increase, however, for patients with sizeable wounds.

Vitamin and mineral deficiencies also require correction. Vitamin A deficiency reduces fibronectin on the wound surface, reducing cell chemotaxis, adhesion, and tissue repair. Vitamin C is required for the hydroxylation of proline and subsequent collagen synthesis.

A positive wound culture does not confirm a wound infection. Opportunistic microorganisms may colonize any wound. Wound exudate, which is naturally bactericidal, inhibits the spread of surface contamination from becoming a deep wound infection. However, when wound ischemia or systemic immune compromise supervenes, pathogenic microorganisms propagate until an excessive concentration of bacteria in the wound precludes healing. This heralds a true wound infection. Multidrug resistant organisms are becoming increasingly common.

Foul-smelling drainage, a spontaneously bleeding wound bed, flimsy friable tissue, increased levels of wound exudate, increasing pain, surrounding cellulitis, crepitus, necrosis, fasciitis, and regional lymphadenopathy characterize the infected wound. Fever, chills, malaise, leukocytosis, and an elevated erythrocyte sedimentation rate are common systemic manifestations of wound infection.

Wound infection requires surgical debridement and appropriate systemic antibiotic therapy. Topical antiseptics are usually avoided because they interfere with wound healing because of cytotoxicity to healing cells.

Proving the absence of osteomyelitis is often as onerous as establishing its presence. Although osteomyelitis may be associated with fevers, malaise, chronic fatigue, and limited range of motion of the affected extremity, patients often present with only a nonhealing wound or a chronic draining sinus tract overlying a bone or joint.

Plain radiographs, CT scans, radionuclide bone scans, and MRIs have a role in the workup of osteomyelitis. All too often, even a comprehensive imaging evaluation is nondiagnostic. Therefore, negative findings on radiologic workup should not deter the clinician from performing curettage of suspicious bone underlying a chronic draining wound.

Gently irrigate the wound with a physiologic saline solution. If cost is a major consideration, the patient can prepare a saline solution at home by using 1 gallon of distilled water and 8 teaspoons of table salt. The solution is boiled and then cooled to room temperature before use.

If surface exudate is present, consider irrigation under pressure. An irrigation pressure of approximately 8 psi can be achieved with saline forced through a 19-gauge angiocatheter with a 35-mL syringe. Pat the wound surface with soft moist gauze; do not disrupt viable granulation tissue.

After debridement, apply a moist saline dressing, an isotonic sodium chloride gel (eg, Normlgel [Scott Health Care], IntraSite gel), or a hydroactive paste (eg, DuoDerm [ConvaTec]). Optimal wound coverage requires wet-to-damp dressings, which support autolytic debridement, absorb exudate, and protect surrounding normal skin.

A polyvinyl film dressing (eg, OpSite [Smith & Nephew], Tegaderm [3M]), which is semipermeable to oxygen and moisture and impermeable to bacteria, is a good choice for wounds that are neither dry nor highly exudative.

For dry wounds, hydrocolloid dressings, such as DuoDerm or IntraSite hydrocolloid, are impermeable to oxygen, moisture, and bacteria. They maintain a moist environment, and they support autolytic debridement. They are a good choice for relatively desiccated wounds.

For exudative wounds, absorptive dressings, such as calcium alginates (eg, Kaltostat [Calgon Vestal], Curasorb [Kendall]) and hydrofiber dressings (eg, Aquacel and Aquacel-AG [Convatec]), are highly absorptive and are appropriate for exudative wounds. Alginates are available in rope form, which is useful for packing deep wounds.

For infected wounds, use silver sulfadiazine (Silvadene) if the patient is not allergic to sulfa drugs. If the patient is allergic to sulfa, bacitracin-zinc ointment is a good alternative. An ionic-silver hydrofiber dressing (Aquacel-AG) is also a good choice. [28, 29, 30, 31, 32, 33]

Alginate dressings are made of seaweed extract contains guluronic and mannuronic acids that provide tensile strength and calcium and sodium alginates, which confer an absorptive capacity. Some can leave fibers in the wound if they are not thoroughly irrigated. These dressings are secured with secondary coverage.

An absorptive textile fiber pad, hydrofiber is also available as a ribbon for packing of deep wounds. This material is covered with a secondary dressing. The hydrofiber combines with wound exudate to produce a hydrophilic gel. Aquacel-Ag contains 1.2% ionic silver that has strong antimicrobial properties against many organisms, including methicillin-resistant Staphylococcus aureus and vancomycin-resistant enterococci. e24fc04721