Wound care health education

For superficial wounds such as cuts, abrasions, and scratches that we encounter in daily life, as long as we do the three core actions of "cleaning, moisturizing, and proper protection," more than 90% of them will not cause infection or leave obvious scars. There is no need to randomly sprinkle anti-inflammatory powder or apply folk remedies, let alone tossing it with changing medicine three times a day.

Last week, I met an Aunt Zhang who was in her 60s at the outpatient clinic. She made a cut of more than one centimeter on her left index finger while cutting potatoes. She sprinkled Yunnan Baiyao at home, wrapped two layers of band-aids and wrapped a rubber band. She didn't dare to wash her hands for three days because she was afraid of getting wet. When she came here, her fingers were swollen like little carrots. When she removed the band-aids, she smelled of pus, and the surrounding skin was so stuffy that it turned white and wrinkled. After cleaning her wound, I only put on a thin hydrocolloid dressing and told her to wash her hands normally and change it every two days. It healed in less than a week and left no scar.

Some people may object to this. When I was a child, I would leave my injuries open to dry out, and then the scabs would heal. Why do I still say I need to moisturize now? This is really not a question of who is right or who is wrong. Dry healing was indeed recommended in clinical practice in the early years, which is to let the wound dry and scab, and rely on the scab as a protective layer to grow on its own. This method is suitable for wounds that are particularly shallow, have almost no exudate, and are in a very clean environment. For example, a small cut on the arm is scratched by paper, and it will heal after two hours of drying. There is really no need to wrap it blindly. However, wet healing, which is now more recommended internationally, refers to keeping the wound moderately moist in a sterile environment without scabbing. New skin cells can crawl over the wound faster, and the healing speed can be about 30% faster. It is not easy to leave scars. It is especially suitable for wounds at joints, abrasions with a lot of exudation, and wounds on the face that are afraid of leaving scars. The two methods are inherently suitable for different scenarios, so there is no need to compete.

However, there are a few pitfalls that I really want to remind everyone not to step on. I have seen too many people make trouble by themselves. A couple of months ago, a college student fell while riding a shared bicycle and scratched a large area on his knee. He used Erguotou to wash the wound at home, and the pain made him cry. When he came over, the good skin around him was red, swollen and blistered by the alcohol. It was originally just a superficial scratch, but it was suddenly irritated and inflamed, and the pain lasted for several days. There are other people who sprinkle cephalosporin powder, apply toothpaste, and apply plant ash on wounds. I have even met people who sprinkle incense ash on children's wounds. These things are not sterile in the first place. Sprinkling them directly blocks the outlet of the exudate. All bacteria are covered in it, so it is strange that there is no infection. By the way, there are people who go to great lengths to rub the inside of the wound with iodophor whenever they are injured. In fact, iodophor only needs to wipe the skin around the wound. Repeated wiping on a fresh wound will kill the newly grown delicate cells, making the wound heal more slowly.

In fact, if you encounter a small wound, you don’t need to panic. First, rinse it with running water or saline solution to clean away all the sand, dust, vegetable residue and other dirt on it. This is the most important thing. Leaving dirt inside is the biggest cause of infection. After rinsing, take a clean medical cotton ball or a lint-free cotton towel and gently dry it with water. If you are worried, just wipe it with iodophor 2 cm around the wound, and then choose a dressing according to the situation: if there is a lot of exudation, use sterile gauze with good absorbency, if there is less exudation and are afraid of leaving scars, use hydrocolloid, and if you are exposed to water, wear a waterproof one. It does not need to be tightly wrapped, but it is better to let it breathe properly.

Many people just take off the dressing to see if it has healed, but don't do this. The granulation tissue that has just grown out is very tender and will break if it is torn, which means the growth is in vain. Generally, if there is a lot of exudation, it should be changed once a day. If there is a little exudation, it is no problem to change it every two or three days. If the hydrocolloid dressing is white, then change it. If it is not white, you don't need to touch it. Someone also asked if you can take a shower if you are injured? As long as you put on a waterproof dressing and quickly dry the area after washing, it's totally fine. There's no need to go without a shower for a week because of a small wound. That would be too much.

There is also the issue of scars that everyone is most concerned about. First of all, if the wound is deep into the dermis, such as a knife cut, a deep cut made by glass, or a stitch, it will leave some marks. If the scar itself is a type of scar, it may even grow. This kind of scar can be reduced a lot by using silicone scar removal cream as soon as the wound has healed. But if it’s just a scratch on the skin, as long as you don’t let it get infected or repeatedly pick at the scab, it will basically leave no obvious scars. Don’t pay the IQ tax on those ridiculously expensive scar removal products.

Oh, by the way, there are a few special situations. Don’t deal with them at home. Go to the hospital immediately: if you are pricked by a rusty iron nail or dirty glass, you will get tetanus.； Anyone who is bitten by a cat or dog and bleeds should be vaccinated against rabies ； If the wound is so deep that fat can be seen, or the bleeding cannot be stopped, you need stitches. ； If the wound is still red, swollen, painful, pus-producing, or has a fever three days after treatment, it must be infected. Don’t delay and see a doctor immediately.

To be honest, I have been treating trauma in the emergency department for almost 6 years. I really feel that there is really no need to deal with most small wounds. The more you deal with it, the slower it will heal. Mastering the core principles and not using folk remedies blindly is better than anything else. If you are really unsure, the community hospital downstairs can handle it for just a few dollars, which is much more reliable than trying to figure it out at home.