Wound care measures

Reduce the risk of infection as much as possible, create a suitable healing environment for the wound, and minimize the probability of scar hyperplasia. All specific operations are centered around these three points. I have been in the dressing room of emergency surgery for almost four years, and I have seen too many cases in which wounds were treated blindly, which eventually led to infection, scarring, and even hospitalization for debridement. To be honest, most people's mistakes are completely avoidable.

Let’s start with the most quarrelsome issue recently: “Whether it is better to leave a wound open or to wrap it?” The two factions are at loggerheads. The older generation believes that scabs will scab quickly if left to dry, and they are not afraid of contact with water. The younger generation believes in moist healing and believes that wrapping is the best. In fact, there is nothing wrong with either view, but it depends on the condition of the wound. For example, if you wear an ankle with sandals in the summer, there will only be a shallow layer of broken skin with very little leakage, and the surrounding environment is clean. If you disinfect it and leave it to dry, there will be no problem. There will be no dirt on it anyway, and it will heal in a day or two. But if you cut vegetables and find fat, get burned and get big blisters, or if you fall outside and get deep scratches filled with mud, and insist on drying them, you are just looking for trouble. Last month, a young man cut a cut on his finger that was almost a centimeter deep while cutting vegetables. It was left open after disinfection. Three days later, the dressing was changed, and a layer of black scab formed on the surface. When pressed, yellow pus came out from the cracks. When the scab was removed, it hurt so much that he pinched my colleague's arm and left a mark. The injury should have healed in a week, but it took half a month. I broke my knee while riding an electric bike last year. I wiped out a large area of ​​oozing fluid. I went home and washed it with saline three times. After sterilizing it with iodine, I put a large hydrocolloid dressing on it. I didn't remove it for three days. When I opened it on the fourth day, the tender skin had grown more than half, and there was no hard scab or black mark. Before, my mother would have forced me to dry it, which would probably hurt for half a month.

When it comes to wound cleaning, there is really no need to just rub it with alcohol or iodine. Many people think that the more painful it is, the more thorough the disinfection will be. This is a pure misunderstanding. How irritating are alcohol and iodine? The tender flesh and mucous membranes of fresh wounds cannot bear it at all. Not only will the pain make you gasp, but it will also kill the growing granulation tissue and slow down the healing speed. There was a little girl who had a two-centimeter cut on her face by her best friend's fingernail. She was afraid of leaving a scar, so she wiped it with 75% alcohol at home repeatedly. As a result, the area around the wound became red, swollen and blistered. The mark should have gone away in a week, but the pigmentation took two months to fade away. She came crying and asked me if my face was going to be disfigured. For normal cleaning, use mild iodophor. If the wound is stained with dirt such as sediment, rinse it with saline first and then disinfect it. If the wound is particularly deep and there is foreign matter stuck in it, do not pick it yourself. Go directly to the hospital to see a doctor for treatment to avoid the risk of tetanus.

As for whether to use antibiotic ointment, there is no completely unified opinion in the industry. One group of people thinks that as long as the cleaning is in place, there is no need to use it, and misuse will increase the risk of drug resistance. ； The other group believes that for wounds with a high risk of contamination, the advantages of using it for two or three days completely outweigh the disadvantages. My own experience is that if the wound is made in a clean environment, such as a small cut made with a clean fruit knife at home, there is really no need to apply disinfectant after disinfection, and there is no need to take antibiotics. But if you fall outside and are stained with soil, are scratched and bitten by pets, or your own immunity is relatively low, you can apply Baiduobang and erythromycin ointment for two or three days, and there is really no problem. Don't use it for more than a week in a row, and there will be no risk of drug resistance.

There is also the most frequently asked question about the frequency of dressing changes. Don’t believe the saying “it must be changed every day to make it clean”. If there is a lot of oozing in the first two or three days after the injury, you really need to change it every day, or even twice a day, otherwise the oozing fluid will soak into the surrounding normal skin and it will easily rot. After three or four days, the leakage has subsided and the granulation has grown. Just change it every two or three days. Just take off the dressing and take a look. I have seen too many cases where the newly grown tender meat is torn every time the dressing is removed. It can't be healed after half a month. It's just a waste of time.

Finally, let’s talk about the scars. Don’t blame the soy sauce anymore. The pigment will have been metabolized long ago and will not go to the wound at all. Instead, pay attention to sun protection. Ultraviolet rays are the number one culprit that causes pigmentation. Try not to sunbathe in the first three months after the wound has healed. If you have a scarring constitution, or the wound is on the face or joints, which are prone to scarring, prepare some silicone patches and silicone cream in advance. Start using it after the wound is completely healed. Use it for two or three months, and it will be more effective than any other folk remedy. There used to be a young man with a scarred body. His chin fell and he needed four stitches. He followed the doctor's advice and wore silicone patches for three months. Now he can't see the scar even if he gets close.

In fact, wound care really doesn’t have that many bells and whistles. The core thing is not to do it blindly. If it doesn’t irritate, don’t irritate it. If you’re really unsure, ask a nurse from a nearby community hospital to take a look at it for you. It’s much more reliable than searching for a bunch of random folk remedies online.