Precautions for wound care measures

The first is to avoid infection caused by the invasion of external bacteria, the second is to create a suitable environment for skin repair to accelerate healing, and the third is to reduce the probability of scar hyperplasia as much as possible. All the various nursing methods you have heard of are essentially centered around these three points. You don’t need to remember so many fancy operations, just focus on the core and you won’t make big mistakes.

Last week at a community free clinic, I met an aunt in her sixties. Her knee was bruised as big as a palm while riding an electric scooter. When she got home, she applied red lotion and covered it with two layers of band-aid for three days. When she removed it, the entire wound was festering and smelly, which scared her so much that she thought she needed amputation. In fact, this kind of superficial skin abrasion is the best to deal with, but because of the misunderstanding of "covering it and applying lotion every day", it is ruined.

Speaking of which, we have to mention a controversial point that has been quarreling in the field of wound care for almost two decades: Should we care for it dry or wet? The classic view of the older generation and traditional surgery is to keep the wound dry and allow the wound to scab quickly, and then the scab will be gone. This idea was no problem when the disinfection conditions were not good and there was no suitable dressing twenty or thirty years ago. At least it can minimize the probability of infection. However, the wet healing theory that is now more respected in clinical practice also states that the wound should be kept in a closed environment with constant temperature and humidity, so that the growth factors secreted by the skin can remain in the local area, new granulations will not be stuck in the hard scab, the healing speed can be doubled, and the probability of scarring is also low. In fact, both statements are correct, and it all depends on the situation: if you scratch your hand while hiking outdoors and there is nothing around you, then wiping it clean and letting it dry to heal is definitely the best solution; if you are at home and can change the dressing regularly, then using sterile hydrocolloid or foam dressing for wet healing is of course more comfortable and heals faster. I fell on a shared bicycle last month and had a large bruise on my palm. At that time, I went to a convenience store and bought bottled mineral water to wash away the sand embedded in the skin. I disinfected it once with iodophor and then applied a hydrocolloid dressing. It completely healed in three days without leaving much of a mark.

Oh, by the way, there is another point that people are most likely to make mistakes: iodophor is really not a panacea, so don’t just rub it on the wound. Many people think that wiping it two or three times a day is enough to achieve adequate disinfection. In fact, the new granulation tissue is like a sprout that has just emerged. If you stimulate it with iodophor every day, it is equivalent to pouring disinfectant on the sprout. On the contrary, it will kill the active new cells and slow down the healing speed. Generally, it is enough to remove the wound once when it is just injured or when the wound is stained with dirt. As long as there is no pus or redness or swelling in the wound, you can use normal saline to gently wipe away the secretions when changing the dressing. There are also red potion and violet potion that have been clinically eliminated long ago. Red potion contains mercury and can easily lead to poisoning if used too much. Purple potion will form a thick scab on the surface, and the pus underneath cannot be drained out but will rot deep down. If you still have these two things at home, throw them away immediately.

Many people ask whether the wound can be exposed to water? There is no standard answer to this either. To clean a newly injured wound, you can use running cold water to rinse it. This can not only wash away foreign matter such as sand and dust, but also constrict blood vessels and stop bleeding. It is much cleaner than wiping it with a dirty paper towel for a long time. But if you have had stitches, or the wound has been infected and pus is leaking, try not to touch the raw water. Put a waterproof dressing on it when taking a bath. Just dry it and change the dressing quickly after washing. Don't be too nervous, it won't rot if it touches a little water.

Don’t think that you don’t need to go to the hospital for small wounds. Don’t bear it when you encounter these situations: deep and narrow wounds punctured by rusty iron nails or dirty wooden thorns must be treated for tetanus. Don’t believe in the saying that “vaccinations are useless after 24 hours”. As long as the disease has not yet occurred, vaccination can play a protective role; Dogs, bats and other animals scratch and bite, even if there is no bleeding but the skin is broken, you must get a rabies vaccine; as well as diabetics and people with low immunity, don’t deal with it by yourself even if it is a small blister or a small scrape. I used to have an old friend with diabetes who had a blister on his foot and didn’t take it seriously. In the end, it was so bad that he almost had his leg amputated. What a pity. If the wound continues to ooze pus for more than a week, is red, swollen and painful, or even has a fever, go to the hospital quickly instead of delaying things by applying ointment at home.

Oh, by the way, there is another small detail that is easy to overlook: if the wound is in a frequently moved position such as a joint or elbow, try to pull it as little as possible, otherwise the newly grown epidermis will be torn repeatedly, and the probability of leaving hypertrophic scars will double. I met a young man who scraped his knee and played basketball for two hours every day. In the end, he was left with a raised scar of almost two centimeters. He dared not wear shorts in the summer and regretted it so much.

In fact, there are really not so many rigid rules for wound care. The core is to follow the skin's own growth rhythm and don't mess around with strange folk remedies. This is better than anything else.