Wound care definition

Wound care covers the entire cycle from the moment skin and mucous membrane damage occurs to the time when the wound completely returns to its normal structure, function and even appearance. It includes all assessment, intervention, follow-up, and daily care behaviors used to reduce the risk of infection, accelerate healing, and reduce long-term adverse effects. It includes both professional operations by medical staff in the hospital and self-care at home. It is by no means as simple as “applying medicine and applying a Band-Aid” as popular perception.

Last week, I was doing a free clinic on wound care in the community. I met Aunt Zhang. Her right knee was scraped for almost a week and was still very swollen. When I opened her trouser leg, I saw a hard black scab on the surface with yellow pus oozing around it. She felt aggrieved: "I apply red lotion at home every day, and I even wrapped it in plastic wrap when I showered to avoid being exposed to water. How come the more I take care of it, the worse it gets?" ” In fact, many people's understanding of wound care is just "don't touch the water and apply iodophor". If you really need to dig deeper, there are far more ways to do it than you think.

Speaking of this field, there have always been different opinions. When I first entered the surgical internship more than ten years ago, my teaching teacher repeatedly emphasized that "the wound should be kept dry so that the scab will heal quickly." At that time, the routine for treating patients with bruises in the outpatient clinic was to use iodine to remove the violet solution, and then let the patient go home without touching the water. In recent years, the concept of wet healing has become popular, and there are many voices saying that "dry healing is an old rule, and moist without scabs is the right thing to do." Some even say that as long as scabs form, the care has failed. Let me tell you, both statements are a bit extreme, and there is absolutely no need to be either/or. For example, the abrasions on the face that are the size of a needle tip have less leakage and are not easily rubbed. They will heal after being disinfected and left to dry for two or three days. If you have to apply a wet dressing, it will make you feel stuffy. ； But if it is a deep abrasion at a joint, a pressure sore in the elderly, or a foot ulcer in a diabetic patient, the advantages of wet healing are indeed obvious. It can not only reduce the pain of dressing change, but also reduce the probability of scar hyperplasia, which is much better than hard scabs.

Last year, I took care of a 72-year-old diabetic foot patient. At first, he only had a small blister on the sole of his foot. I opened it at home and applied some iodophor, thinking that "such a small wound was well taken care of." However, after half a month, the tendon was rotten and almost required amputation. Later, we performed wound debridement and negative pressure drainage on him. We also had to keep an eye on him every day to control his blood sugar and ask his family members to turn him over regularly to avoid stress. It took more than three months of painstaking efforts before it healed. You see, wound care at this time is no longer just about the wound. The control of basic diseases throughout the body, the improvement of peripheral blood circulation, and even the adjustment of the patient's diet and rest are all part of the care.

In daily outpatient clinics, I often encounter young people who cut their hands while cutting vegetables. They put a band-aid on after running the tap water for three days. As a result, when they were removed, the wound was white and soaked. They asked me, "Didn't I take care of it? Why is it still not good?" ” In fact, if such a small wound is shallow and does not bleed much, it can be washed clean and disinfected with povidone iodine. You can even leave it without a band-aid, and it will scab after leaving it dry for a long time. If it needs to be exposed to water, it will be temporarily applied and then removed when it is done. It is much better than leaving it alone. Oh, by the way, if you were pierced by a rusty nail, or the wound is so deep that you can see the fat, you have to consider whether you need tetanus or whether you need debridement and suturing. These are also prerequisites for wound care. Care is not called after the wound is rotten.

I have been a wound ostomy surgeon for almost 6 years. The one misunderstanding I want to correct the most is that many people think that "the wound is not inflamed and has grown" means that the care is in place, but this is not the case at all. A few months ago, a little girl broke her jaw while riding an electric scooter. She received stitches in the emergency room. She changed the dressing every day at home. The wound was indeed not infected, and the stitches were removed after ten days. As a result, she always felt itchy and picked at the scab every day without using sun protection. In the end, she was left with a very obvious hypertrophic scar. She came crying and asked me if I could remove it. In fact, if she had started using tape after removing the stitches, paid attention to sun protection, and didn't pick randomly, the scar would have faded to the point where it was almost invisible. So you see, the end point of wound care is never "wound healing", but to restore it to the state before the injury as much as possible, without affecting subsequent functions or affecting the appearance too much.

In fact, to put it bluntly, there has never been a unified standard answer to wound care. It is a completely personalized matter. For the same scratched hand, young people with good health may just treat it casually, but patients with blood diseases with low immunity may need to be strictly disinfected and change dressings regularly before they can rest assured. Don’t always think that only what doctors and nurses do is called wound care. Don’t pick at scabs, diabetics wear soft-soled shoes to avoid rubbing their feet, and pay attention to sun protection on wounds that have just had stitches removed. These seemingly inconspicuous little things are all part of wound care.