Wound care definition

Wound care is an integrated care behavior for various types of skin and subcutaneous tissue injuries. It covers debridement, infection prevention and control, tissue repair support, functional recovery intervention, complication prevention and supporting health guidance during the entire cycle from injury occurrence to complete healing. It includes both professional operations in medical institutions and self-care at home. The core goal is to shorten the healing time, reduce the risk of scars and functional damage, and ultimately improve the quality of life of the injured.

Does this sound a bit dry? I just picked up a 17-year-old high school student at the wound clinic last week. He broke his knee while riding a mountain bike. I went home and wiped it three times with povidone iodine, put on a thickened Band-Aid, and then went to play ball. Three days later, it was so swollen that I couldn't even put on my jeans. When I took off the Band-Aid, there was yellow-white pus all over it. The young man felt aggrieved: "Didn't I disinfect and bandage the knee frequently as told on the Internet?" Why is it still serious? ”You see, most people’s understanding of wound care is still limited to the six words of “applying ointment and bandaging”. Even many non-specialist doctors and nurses may not be able to fully explain this definition.

It should be mentioned here that there are still two factions in the wound care circle who are arguing with each other from time to time: one group has believed in the dry healing concept for decades, and believes that the wound must be left to dry and scab to heal quickly. The red lotion and violet lotion that the older generation is familiar with are products of this concept, but now because red lotion contains mercury and violet lotion will cover up the wound condition, they are rarely used clinically.； The other school is the wet healing concept that is gradually becoming popular. It is believed that a suitable moist environment can double the crawling speed of epithelial cells and avoid the risk of pus accumulation under the scab. Hydrocolloids and foam dressings commonly used in clinical practice are designed for this scenario.

I had an argument with my retired director when I was out for a clinic. The old director slapped the table and said that I have been doing surgery for more than 40 years. After surgery, the patient is asked to change the dressing every three days and keep the wound dry without touching the water. There are not many infections. The wet healing you are doing now will make it easier to cover up the sticky wounds. This is actually true. At that time, most of the wounds he received were clean surgical sutures. There was little leakage, the wounds were neat, and the dry environment was indeed enough to meet the healing needs. But if you try it with a pressure ulcer patient who has been bedridden for three years and has a rotten hole in his sacrococcygeal area, if the wound is left to dry according to dry healing, the wound will reach the periosteum in less than a month. In the final analysis, the two concepts are never either-or. It depends on the specific situation of the wound. I also tried it later. For small abrasions with only damaged epidermis and almost no leakage, if you find it troublesome to apply a dressing, just let it dry and keep it dry, and the scab will heal in two or three days. There is no need to pursue high-end dressings, which cost money and trouble.

I have been working in this industry for almost eight years, and the most common misunderstanding I have seen is that "disinfection" is everything in wound care. There is an aunt in her seventies. Every time she brings her grandson to change the dressing, she carries three bottles of iodine in her bag. She rubs the child three times in the morning, noon and evening at home. The skin around the wound becomes red and flaky, and she keeps saying, "Please disinfect more often to avoid rotting." In fact, it is completely unnecessary. Disinfection only needs to target the healthy skin around the wound. It is enough to rinse the wound itself with normal saline. Disinfectants such as iodophor and alcohol will kill all the newly grown cells when they come into contact with fresh granulation tissue, which will slow down the healing speed. There are also many people who think that the more frequent dressing changes, the better. The most exaggerated patient I have ever seen was that he would change band-aids on his hands four times a day, tearing the newly formed scab every time. The small wound that should have healed in three days took half a month to heal.

To put it bluntly, wound care is actually not much different from planting flowers: necrotic carrion is a weed, and it must be cleaned first before new ones can grow.； Different dressings are different types of soil. Wounds that ooze a lot should use absorbent foam dressings, and cracks that dry out quickly should use oil gauze to moisturize them. ； You also need to give some "fertilizer", such as growth factors and other repair products. ； We also need to prevent "pests", that is, pathogenic bacteria. Patients with low immunity may also need to take some anti-infective drugs. Just sprinkling some "pesticides" (disinfectant water) will not make everything fine.

A travel friend came to my place for dressing change before. He said that he fell while hiking in the mountains and rubbed off a large piece of skin on his arm. There was no disinfectant around at that time, so he rinsed it with mineral water, wrapped it with a clean outdoor turban, and walked for three days before going down the mountain. When he came, the wound was actually very good, and he recovered faster than many patients who randomly apply various Internet-famous wound healing ointments and folk remedies at home. You see, the definition of wound care is never a rigid operating procedure written in a guide. It must be flexibly adjusted according to the person, the wound, and the environment. The ultimate goal is always to make the wound grow faster and make the patient suffer less. That is enough.