A wound is a damage to the normal structure and function of the skin. It could be referred to as a disrupted skin architecture.
Medical care of wounds by a wound care specialist is critical to overcoming obstacles to natural wound healing. Amongst the aims of wound care is to reduce contamination, minimize new tissue proliferation and keep the granulation tissue and the healing area moist/clean. However, wound care specialist efforts at facilitating wound healing at wound care center sometimes introduce new impediments to the wound.
Before the inception of modern medicine, many cases of wounds do not heal probably because they are very big or may have undergone excessive blood loss and/or have been infected.
With the existence of modern medicine, natural healing mechanisms now have greater success rate. There are now approaches to stop bleeding, clean wounds well and effectively protect (surgically close) large wounds.
The approaches to modern wound care (basics of wound care) are in the order: inspect wound, clean (wound dressing), close and cover the wound.
The first step in the treatment of acute wound is to stabilize the patient. In the course of wound care/treatment, any life threatening condition must be treated first. These could be problems related to breathing, airway and circulation.
After stabilizing the patient, the wound treatment procedure should be planned and prioritized by a physician.
The wound care basics proper!
Take a complete history
This is done in line with the order of the treatment plan. A history is usually taken in treating an external wound. This will include finding out the cause of the wound and the environment in which it occurred.
The following details should also be considered while taking a history:
- Any underlying patients’ chronic illness;
- Medical conditions;
- Current medicines;
- Allergies and
- Any immunization history for tetanus.
Anesthetize the injury after proper examination
The wound care specialist or a physician (any other healthcare professional if protocols permit) examines the wound; check the depth, the degree of contamination as well as the internally injured tissues.
Clean the wound
Wounds are usually cleaned from the centre going outward in order not to contaminate the wound. Interfering hairs should be clipped and the regions adjacent to the wound washed with an antiseptic solution.
Close the wound
After washing/cleaning the wound, it is usually made dry with a sterite gauze starting from the center of the wound and moving outwards while wiping the skin around the edges. Closing the wound reduce the risk of infection and may also determine the size of scars.
General plans for wound closure
Primary wound closure: This is known as healing by immediate direct closure and it is done by suturing, stapling, taping and/or gluing.
Secondary wound closure: Here, the wound is allowed to contract/develop epithelial cells on its own. This is known as an indirect closure and it usually leave a larger scar. On the other hand, this closure plan reduces the risk of infection for highly contaminated wounds.
Delayed primary closure: Here, the wound is initially left open and is later closed with sutures or staples. This is known as tertiary wound repair. This approach is used for highly contaminated wounds that may require repeated debridement and/or an antibiotic treatment prior to closure.
Cover the wound
After dressing the wound, the wound surface is usually cleaned with moistened sterile gauze after which it is covered with a sterile dressing and a protective bandage.
Depending on the physician’s approach to the wound treatment, a non-adherent and medicated strip may be placed over a sutured/stapled wound. Topical antibiotics and/or ointments should be applied appropriately. Do not use antibiotic ointments on a clean wound. Instead this should be used for infected wounds. Whether the wound is an open or a closed type, it should be covered with a dressing (covering laid over a wound).
Dressings for wounds should be changed at intervals to help assess the wound condition and the progress of the healing process. Large amount of wound drainage and/or infection requires frequent changing of the wound dressing.
Tetanus prophylaxis, rabies prophylaxis is or systemic antibiotics may be used in some cases.
A wound is said to be an open type when it is an injury involving an external or internal break in body tissues. It usually involves the skin most of which are minor wounds, hence can be taken care of at home.
The types of open wounds are abrasion, incision, laceration, puncture and avulsion.
- Abrasion sets in when one’s skin rubs against a hard surface.
- Incision: This could be as a result of a cut by a sharp object (knife or razor blade).
- Laceration: Tearing of the skin or deep cut by machineries.
- Puncture: A small hole by a sharp object.
- Avulsion: This is a partial or a complete tearing of the skin and/or tissue.
Open wound care
These are minor wounds and can be treated at home. The steps to treat open wounds include:
- Wash and disinfect the wound;
- Control bleeding/swelling by direct pressure and/or elevation;
- Use sterile dressing/bandage to wrap the wound;
- Keep the wound clean and dry for few days;
- The patient should have enough rest during this period;
- Give Acetaminophen for pains;
- Avoid aspirin as this can cause bleeding;
- Use ice for bruises and swells;
- Use a sun protective factor (SPF) 30 if patient is always exposed to sunlight
Wound care should be done in the proper way and on time to avoid complications. Patients whose cases are complicated should see a doctor.