Basic Steps in Wound Care

The core steps of wound care can be summarized into the five core links of "hemostasis - cleaning - disinfection - wound care - observation". In actual operation, it needs to be flexibly adjusted according to the type of wound, degree of contamination, and patient's constitution. There is no absolutely unified standard process.

Speaking of hemostasis, I think of the young man I met at the community clinic last month. He fell on his knee while riding a shared bicycle. As soon as he entered the door, he held up his bleeding leg and asked for iodophor. I pinned him down on a chair and held him with a sterile cotton pad for two minutes before he spoke. In fact, there is no need to panic for bleeding from ordinary epidermal abrasions. Pressing a clean gauze, cotton pad or even a clean handkerchief on the wound for 1-3 minutes will basically stop it. There is also a small controversy here: the old version of the care guide requires that the affected limb be raised above the heart at the same time. The latest trauma guideline believes that this extra step is not necessary for superficial bleeding. Only when the wound is deep and subcutaneous blood vessels are injured, it is necessary to lift the limb. On the contrary, if the injury is an arm or leg, random lifting may cause the wound to aggravate the pain.

Many people’s first reaction after stopping bleeding is to take out disinfectant. In fact, they miss the most critical step: cleaning. Clinically, there are currently two groups regarding clean water: one group insists on flushing with sterile saline to avoid the intrusion of bacteria; the other group believes that boiled water and even bottled water that meets drinking standards can be used in household settings. After all, flushing out large contaminants first is the highest priority. Concerning whether the water is sterile can easily waste time. When I treat the wound in the outpatient clinic, I usually first check the degree of contamination of the wound: if it is stained with mud, takeaway soup, or roadside dust, first flush it with running water for 30 seconds to 1 minute to wash away all visible dirt, and then rinse it with physiological saline. By the way, there is another old controversy: Can hydrogen peroxide be used on superficial wounds? The current mainstream view in dermatology is that it is not recommended. The strong oxidation of hydrogen peroxide will destroy the new granulation tissue and slow down the healing speed. Only wounds that are particularly deep and heavily polluted will consider using it to initially flush anaerobic bacteria.

After cleaning, it’s time to disinfect. There are too many people here. An aunt had a cut lip before and she applied alcohol at home, which made her cry and became swollen for two days. She just didn’t understand the applicable scenarios of different disinfectants: try to use iodophor, which is less irritating, for mucous membranes and the delicate skin of infants and young children, and avoid alcohol and iodine. People who are allergic to iodine use iodine-free disinfectant products such as benzalkonium chloride. I just met a patient allergic to iodine last week. After applying iodine at home, a red rash appeared around the wound, which delayed the healing time. If the wound is on the face, try to choose a disinfectant product without pigmentation. Do not use iodine or violet solution to avoid leaving marks.

Do I need to wrap it after disinfection? This is a topic that has been debated in the wound care field for almost ten years. The older generation always thinks that it needs to be wrapped tightly to avoid stains. Young people now believe that "drying and exposure will heal faster". There are also schools of wet healing that say that hydrocolloid dressings should be applied to avoid leaving scars. To be honest, all three are correct, it all depends on the situation: if the wound is on a joint, easily rubbed when wearing clothes every day, or if you are going to a dusty place, just wrap it with a thin layer of sterile gauze, and change the observation state every day; if the wound is on the arm or neck, which is not usually touched, it can be completely exposed even if the temperature is high in summer, as long as it does not get dirty Water will do; if you have scars, or the wound is in an exposed area and you are afraid of scars, choosing a qualified hydrocolloid dressing for wet healing can indeed reduce the probability of scars. For example, last time a beauty-loving high school student dropped her knee and was crying for fear of leaving scars. I rinsed her, disinfected, and applied a hydrocolloid dressing. After seven days, the scabs fell off, leaving almost no marks. Oh, by the way, if you are a diabetic or immunocompromised person with poor wound healing ability, you should give priority to moist healing dressings, which can reduce the risk of infection.

Don’t think that everything will be fine after treatment. Follow-up observation is the key to avoiding infection. If the wound still hurts 2-3 days after treatment, if the area of ​​redness and swelling becomes larger, there is yellow exudate or even pus, or even if the person starts to have a fever, don’t hesitate and go to the hospital quickly. It is most likely infected. There are also several special situations that you should not bear on your own: deep wounds punctured by rusty metal or dirty wooden thorns must be treated with tetanus antitoxin; those scratched and bitten by animals must go to the Centers for Disease Control and Prevention for rabies vaccination in addition to routine washing and disinfection; people with high blood sugar must pay more attention to even small wounds. Poor blood sugar control can easily develop into chronic ulcers.

Actually, the wound is like a small vegetable patch that has just been turned over. You have to clean the stones and weeds inside first, and then give it a suitable growing environment. Don't water random things, so that it can grow well. If you really have an uncertain deep wound, or there are no signs of improvement after three days of treatment, it is much more reliable to go directly to a doctor for treatment than to follow the steps online.