Wound care measures

First evaluate the wound type to eliminate high-risk risks, and then control the infection in a targeted manner while maintaining an appropriate healing environment. The ultimate goal is to shorten the healing time and reduce the occurrence of scars and complications as much as possible.

To be honest, many people's understanding of wound care is still stuck in the old routine of "applying iodine, applying Band-Aid, and waiting for scabs to form." Last time in the emergency department, I met a young man who fell on his knee while riding a shared bicycle. I sprinkled a thick layer of Yunnan Baiyao on the exuding wound at home, and wrapped it with two layers of gauze to stuff it for two days. When it came, there was yellow-white pus under the hard scab, and when the scab was removed, the pain made him break out in a cold sweat.

This actually involves a controversy that has been quarreling in the wound care community for many years: Is dry healing or wet healing better? People of the older generation always think that the wound should be left to dry, and a hard scab means it is almost healed. This is actually the idea of ​​​​traditional dry healing, which is suitable for small abrasions that are very shallow, with only superficial damage and almost no exudation. For example, if the arm rubs against the wall and some skin falls off, a thin scab will form after being disinfected and left to dry for a long time. There is really no need to wrap it up. But now the mainstream wet healing theory in the world is more suitable for most wounds with exudation and the depth reaches the dermal layer. Simply put, it means covering the wound with a dressing, keeping the temperature and humidity constant, allowing the granulation tissue to grow slowly along with the exudation, and will not be stuck by the hard scab. Moreover, the new tissue will not be ripped off when the dressing is removed, and the probability of leaving scars is much lower. I cut my finger while cutting vegetables last time. The wound was deep and the bleeding could not be stopped. After disinfection, I put a hydrocolloid dressing on it. It was not exposed to water for three days. When I took it off, it had grown a lot, and even the scab did not form. Now there is almost no mark.

However, don’t think that wet healing is a panacea. When encountering high-risk wounds such as cat scratches, dog bites, or rusty iron nails, the first step is definitely not to find a dressing. My best friend was scratched by a stray cat last month. She immediately listened to my advice and washed the wound with soapy water for fifteen minutes, squeezing the blood while washing it. After washing it, she disinfected it with povidone iodine and went straight to the CDC to get a rabies vaccine. Such wounds that are at risk of contracting rabies and tetanus should not be left alone. They should be exposed as much as possible, and they must be dealt with by professionals as soon as possible. Don't take chances.

There are still many people who are confused about what to use for disinfection. Which one should I choose between iodophor, alcohol, iodine, and amriodine? In the past, the old nursing standards also required the use of alcohol to disinfect wounds, but most guidelines now do not recommend it - alcohol is too irritating, and it will not only hurt the wound, but also burn the new granulation tissue, which will slow down the healing. But that doesn’t mean alcohol is completely useless. It’s perfectly fine to wipe the intact skin around the wound with alcohol, and the disinfection effect is no worse than iodine. As for red potion and violet potion, it is no longer recommended to use them. Firstly, the color is too dark and it will cover up the wound. Secondly, it contains mercury. If used too much, there is a risk of poisoning. Just throw away the medicine at home as soon as possible.

There are many small details that are easy to get stuck in daily processing. For example, don't wrap the band-aid too tightly. Last time, a child's hand was cut by a piece of paper. The parents were afraid that the child would touch the water, so they wrapped the band-aid several times and tightened it deliberately. After a day, the child's fingertips turned blue, almost causing ischemic necrosis. Also, don’t put toothpaste, soy sauce, or incense ash on the wound. My grandma always said that soy sauce can stop bleeding. The last time my brother fell, she almost poured it on the wound, but I stopped her. These things have not been sterilized, and the bacteria they bring in can easily lead to infection, and in severe cases, it can lead to tetanus. It is completely unhelpful.

If you encounter more complex wounds, such as pressure ulcers for bedridden elderly people and foot ulcers for diabetic patients, the care logic will be more individualized. Nowadays, some grassroots hospitals are still accustomed to using baking lamps to bake pressure sore wounds to keep them dry, thinking that this will reduce the risk of infection. Many doctors also recommend using foam dressings and hydrogels to create a moist environment for the wounds. In fact, both methods have applicable scenarios - if the wound exudates a lot and a serious infection has occurred, it is safer to bake the wound first to reduce the exudation and control the infection. It is not too late to switch to a wet healing method after the infection is under control. There is no need to stick to one theory.

In fact, to put it bluntly, there is never a standard procedure for wound care that is universally applicable. After all, everyone’s wound condition and physical foundation are different. When you are not sure, don’t hold on to it. Ask a community doctor or emergency nurse to take a look. It is much more reliable than searching for folk remedies online for half a day.