Wound care definition

Wound care is a clinical intervention system that covers the entire process of injury prevention, wound assessment and treatment, complication prevention and control, functional and appearance restoration, and patient psychological support. The core goal is to minimize long-term effects such as scarring and functional damage on the basis of promoting wound healing, and to improve the patient's quality of life.

To be honest, when I first rotated in the emergency dressing room, I met too many patients who had misunderstandings about this matter. What impressed me most was a young man who fell on his knee while riding an electric bicycle. He applied red lotion at home for three days. When he came back wrapped in thick gauze, he took off the gauze and there was a fishy smell. Most of the pus had accumulated under the scab. He was particularly aggrieved: "I disinfected every day and never touched water. Why is it still serious?" ”He thought wound care was just a matter of disinfecting the skin and putting a band-aid on it. He didn't know that scabbing didn't mean healing. Instead, the accumulation of pus under the scab would suffocate and kill the tissue that could have grown.

Everyone’s cognitive bias about wound care is essentially that they don’t realize that its coverage is much wider than “post-skin treatment”. Oh, by the way, there was an old man with a 12-year history of diabetes. He cut his toenails and cut a small hole the size of a needle tip. He didn't take it seriously. Half a month later, his feet were so swollen that he couldn't wear shoes. When it was delivered again, it was already in the early stages of osteomyelitis and he almost had half of his toes amputated. It is precisely because there are so many such cases that the industry has already included "pre-emptive prevention for high-risk groups" in the scope of wound care - for example, teaching diabetic patients how to choose loose shoes, how to measure the skin temperature of the feet, and teaching family members who have been bedridden for a long time how to turn over and how to check whether the sacrococcygeal area is red. These things that seem to have nothing to do with "wound treatment" are precisely the most cost-effective parts of wound care.

At this point, I have to mention the differences in healing concepts that have been quarreling in the industry for many years. There is no absolute right or wrong, but the applicable scenarios are different. Many older generation of doctors and nurses prefer the "dry healing concept", which is to keep the wound dry and scab over as soon as possible. This method is indeed suitable for very shallow scratches with almost no leakage. For example, if the skin is rubbed on the hand, there is not much bleeding, and the scab will fall off after two days. It is low-cost and convenient. However, in 1962, Dr. Winter confirmed through pig skin experiments that the migration rate of epidermal cells in a wet environment is twice that of a dry environment. The "wet healing concept" is now used more and more widely. For example, burns, pressure ulcers, and incisions with liquefied fat after surgery that reach deep into the dermis are covered with wet dressings such as hydrocolloids and foam dressings, which can absorb exudate and provide a moist repair environment for the wound. The healing speed can be one-third faster and can also reduce scar hyperplasia. I met an old woman with a stage 2 pressure ulcer on her sacrococcygeal area. Her family members used to wipe the wound with alcohol every day, saying that it needed to be disinfected.

In the past two years, a group of clinicians have put forward a more "counter-intuitive" view of "minimalist intervention". They believe that as long as the patient does not have underlying diseases such as diabetes and immune deficiency, and the wound is not obviously contaminated, they should use as little irritating disinfectants as possible, change dressings less frequently, and rely on the body's own repair ability to heal. I have tried it myself. Last time my niece had a small cut on her face from a branch. Her mother originally wanted to buy a bunch of disinfectant ointments and scar removal products, but I asked her to just lightly rub it with saline every day, apply sunscreen and avoid touching dirt. In the end, no marks were left, and the recovery was better than if she applied ointments every day. However, this view is also controversial. Many primary care doctors think it is too risky. If potential contamination is missed, it will easily cause problems. It is still in the discussion stage.

What many people don’t know is that today’s wound care has long gone beyond just focusing on the wound. Last month, a girl had a 3cm gash on her face cut by glass. She cried every day after the stitches, fearing that she would be left with a scar and unable to marry. Every time I changed her dressing, I would tell her how to use tape reduction and scar injection in the later stage. It was really hard to see it after the wound had healed. She even gave me a cup of milk tea afterward. Would you say this kind of psychological comfort is part of wound care? It must count. If she is so anxious every day that she cannot sleep well, it will affect the speed of wound healing.

In the final analysis, wound care is never a mechanical process that follows a guide. What you are facing is not a piece of damaged skin, but a living person. You must consider whether he has underlying diseases, what his financial situation is, and whether scars will affect his life. Choose the most appropriate plan so that he can suffer less and return to normal life quickly. This is the most fundamental meaning of this matter.