Correct wound care concepts

The plan should be dynamically adjusted based on the stage, type and individual basic conditions of the wound, taking into account infection prevention and control and a suitable healing environment. Black-and-white statements such as "it heals faster if left to dry" and "iodine is universal" are all misunderstandings.

Last week, I met a 19-year-old young man in the dressing room of the outpatient clinic. He fell on his knee while riding an electric bicycle. He limped in with a semi-scabbed wound, and hard marks of dried exudate on his trousers. He said that he had checked the instructions at home and it was said that the wound should be left open and not wrapped. He applied violet at first, but later found out that violet caused cancer, so he changed it to iodophor. He applied it three times a day and deliberately wore his shorts open. As a result, after three days, not only was the wound not healed, but the surrounding area was swollen and it hurt when pressed. I peeled off the semi-soft scab, and there was stuffy purulent exudate underneath. When I cleaned it, the young man screamed in pain and looked aggrieved. In fact, violet solution is not a scourge, but its staining will hide the true condition of the wound. Nowadays, it is not recommended for use in open wounds clinically. This is another common misunderstanding.

Don't tell me, this is a question I have to explain almost eight times a day - the opinions on wound care are really divided now. Some people say that it must be wrapped and moisturized to nourish, while others say that it is better to leave it open for scabbing. It is very quarrelsome. In fact, both opinions are correct, but the applicable scenarios are completely different.

The old saying that "the scab heals faster if left to dry" is actually the experience passed down from the past when there was a lack of medical treatment and medicine. It can also be regarded as a folk simplified version of the traditional surgical dry healing concept. In the past, there were no special wet dressings. If the wound exuded a lot, it would easily get stuffy when wrapped. Simply leaving it open to let the exudate dry and scab is equivalent to covering the wound with a temporary "protective shell." As long as it is a small wound that is superficial, has very little exudation, and is not easily rubbed, such as a little oily skin on your hand and not much bleeding, this method is completely fine and even saves trouble.

But if you apply this experience to all wounds, problems will easily arise. As early as 1962, British zoologist Winter confirmed through experiments that in a moderately humid closed environment, the migration speed of epidermal cells is twice that of a dry scab environment. To put it bluntly, new skin crawls faster, there will be no secondary damage due to scab pulling, and the probability of scarring is low. This is also the origin of the wet healing concept that is now mainstream in clinical practice. However, many people have a deep misunderstanding of this concept. They think that "wet" means that you can touch water, or soak the wound in disinfectant. Last time, an elder sister chopped vegetables and cut her hands. She soaked her hands in iodophor every day for "wet healing". When she came, the whole finger was wrinkled like a fungus soaked in hair, and the superficial skin was burned by iodine.

In fact, the "wet" in wet healing refers to the use of functional dressings to appropriately retain the exudate of the wound, while isolating external bacteria. It will not be so dry that it hurts the new flesh, nor so wet that it will damage the skin. For example, if a wound on a joint such as the knee has an open scab, the scab will crack when you bend the leg, causing pain and repeated injuries. If it is wrapped with a hydrocolloid or foam dressing, daily walking and bending the leg will be almost unaffected, and the wound will heal quickly. I got a thumb-sized blister due to oil splashing while cooking last month. At first, I found it boring to apply it, so I thought of leaving it to dry. However, it broke when I rolled over at night, and the oozing fluid flowed all over the sheets. So I just applied a hydrocolloid, and it basically healed in three days, without even leaving a mark.

Many people come up and ask, "What is the best medicine to apply to my wound?" In fact, the first step of debridement is ten thousand times more important than applying medicine. Last time, an auntie was buying pineapples at the vegetable market and was cut open by the stall owner's knife. Her first reaction was to grab a handful of incense ash and sprinkle it on to stop the bleeding. She said this was used in her hometown, but when she came, the area around the wound was red and severely infected. Think about it, if there is dust, foreign matter or even dirt on the wound, if you don’t wash it off first, apply more iodophor and sprinkle more “magic medicine”, the dirt will be sealed in the wound, so it won’t get infected. For ordinary superficial wounds, the first step is to rinse the foreign matter with flowing saline or clean water, and then disinfect it with iodophor. Next, whether to wrap or dry it all depends on the condition of the wound.

Not to mention that everyone’s basic situation is so different. Where can there be a unified standard? For ulcers of the lower limbs, healthy young people may need to change wet dressings twice. If a diabetic patient also has arterial occlusion of the lower limbs, using a dressing that is too wet will easily breed anaerobic bacteria. Instead, the dressing must be properly kept dry, and the focus is to control blood sugar and improve blood supply. There are also people who are allergic to iodine and experience redness and swelling when applying iodophor. They can just use benzalkonium chloride for disinfection. Is there any reason why "iodine must be used"?

In fact, to put it bluntly, wound care is really not a knowledge point that needs to be memorized. There is no need to worry about which school to choose. It just depends on the condition of your own wound: it is a small tear, does not exude much, will not be rubbed, and is completely fine if it is left to dry.； If the wound is deep, exuding a lot, is at a joint, or is easily rubbed by clothes, it is absolutely right to wrap it up honestly. If you're not sure, don't try blindly on the online guide. Spend a few bucks to go to the dressing room of a community hospital and let the nurse take a look. It's much more useful than doing three hours of popular science at home - after all, the wound is on your body. Whether it hurts or is better, your own feelings always come first, right?