Wound care precautions

Don’t apply random folk remedies with unknown ingredients, assess the degree of contamination and depth of the wound before treatment, and dynamically adjust the plan according to different stages of healing. All other precautions are an extension of these three points, and there are not so many fancy rules.

Speaking of applying things, I have to mention the highly controversial traditional Chinese medicine Zhixue Powder. A patient argued with me before, saying that the elderly at home have been using Yunnan Baiyao to spread wounds to stop bleeding. Why can't it work? Objectively speaking, Western medicine generally does not recommend spraying medicated powder directly on open and contaminated wounds. Firstly, the medicated powder will easily agglomerate with the exudate on the wound. It will be extremely painful to scrape off during debridement, and foreign bodies will easily remain and affect healing. However, there are also opinions from traditional Chinese medicine surgery. The truth is, if it is a clean, small wound that has just been scratched and does not bleed much, using compliant traditional Chinese medicine powder can indeed quickly stop the bleeding. You don’t need to be black and white, just choose according to the situation. If you are really unsure, don’t spread it first. Pressing with clean gauze is equally effective to stop bleeding. I just treated a young man who fell on his knee while riding an electric bike last week. He applied a thick layer of toothpaste and sprinkled an unknown powder on his knee after listening to the advice of his elders at home. When he came in, the wound was heavily battered and there was a big red circle around it. When the wound was debrided, he screamed and was so painful that his clothes were wet with sweat. It was completely unnecessary.

There are also many people who have a deep-rooted belief that wounds should be left to dry and should not be exposed to water, otherwise they will rot. I met a junior high school kid two months ago. He fell on his elbow while playing basketball and scratched a large area of ​​his skin. My mother wrapped him in three layers of thick gauze for almost a week. When they were removed, the skin around the wound was white and wrinkled with sweat, and the wound was still oozing. In fact, how can it be so absolute? For superficial abrasions and little oozing, it is of course faster to disinfect and keep them dry. However, if it is a deeper wound with a lot of oozing, or a joint that moves frequently, it is more recommended to use a wet healing dressing, such as a hydrocolloid or foam dressing. The dressing can not only absorb the exudate, but also provide a moist environment for the wound surface to promote the growth of granulation. As long as the edge of the dressing is firmly attached, it is no problem to touch a little water in the shower. It is much better than covering the wound with thick gauze and suffocating.

When it comes to disinfection, many people keep alcoholic iodine and hydrogen peroxide at home, and they apply it on each person when they are injured. Last time, a little girl cut her finger while cutting vegetables. She first washed it with alcohol, then poured in hydrogen peroxide and finally applied iodine. When it came, she was so painful that she burst into tears. In fact, it was completely unnecessary. Alcohol is too irritating and cannot be used to clean open wounds. It will only destroy the intact skin around the wound. Hydrogen peroxide is more suitable for wounds that are seriously polluted and have necrotic tissue. Using it on ordinary small wounds will destroy the new granulation tissue and slow down the healing speed. For daily small wounds, rinse the dirt with normal saline and apply a layer of iodophor. Don't bother yourself. Oh, yes, someone also asked me if iodophor will leave a black mark? I was spilled on the back of my hand by oil when I was cooking last year. I apply iodine every day, and now there is no trace left at all. Those who have pigmentation after the wound heals are either not wearing sunscreen, or the wound is deeply damaged into the dermis. It really has nothing to do with iodine.

There are also many people who take cephalosporins and amoxicillin when they are injured, in the name of preventing infection. This is really over-medical treatment. Unless your wound was punctured by rusty nails or dirty wood, or there are signs of infection such as increased redness, swelling, pus, or fever, you need to use antibiotics under the guidance of a doctor. Ordinary antibiotics for cleaning wounds are not only useless, but will increase the burden on the liver and kidneys, which is completely unnecessary. Let me also mention the topic of tetanus. Many people can’t tell when to get vaccinated. Here is a simple criterion: If the wound is shallow with a clean object that is frequently touched every day, just squeeze the blood, rinse, and disinfect. If the wound is caused by something buried in the soil or rusty metal, especially if the wound is deep and narrow and creates an anaerobic environment, you must go to the hospital for a tetanus injection within 24 hours. This is a hard rule, don’t leave it to chance.

I have been working in outpatient clinics for so long, and I have seen too many patients whose small wounds became infected due to careless care, and ended up requiring infusions or even secondary debridement. In fact, most of the pitfalls can be avoided. If there are any universal precautions, don't apply other people's experiences to your own. If the wound is deep or contaminated, seek medical treatment directly. Also observe changes in small wounds. If fluid is still oozing for 3 days and the pain is getting worse, don't bear it. A visit to the hospital is better than anything else.