Wound care definition

Wound care is not a simple operation of "applying medicine and wrapping gauze to the broken skin" as popularly believed. It is a systematic medical care behavior that covers the entire cycle from the initial stage of wound formation to complete recovery (including functional and appearance recovery), integrating wound assessment, precise intervention, complication prevention and control, systemic support, and psychological counseling. The core goal is to shorten the healing time, reduce the risk of sequelae, and improve the patient's quality of life.

Last year, when I was doing a free clinic for elderly chronic diseases in the community, I met an Aunt Zhang who had been suffering from type 2 diabetes for 12 years. She had a blister the size of a soybean on the sole of her left foot. She cut it off and put a band-aid on it at home, but ignored it. As a result, half a month later, her entire foot was so swollen that she couldn't wear shoes. When she came to the clinic, the wound was already rotten to the tendons. It took three debridements, and it took more than two months of medication before it finally healed. If she had taken proper wound care when the blisters first appeared, she wouldn't have suffered this problem at all.

Nowadays, many people's understanding of wound care is still limited to the two-step process of "disinfection and bandaging". In fact, even if it is the same abrasion, the treatment ideas for different situations are very different. There are currently two mainstream directions for the treatment of shallow acute wounds in the world: The European Wound Management Association (EWMA) has promoted the concept of "moist healing" for more than ten years, believing that maintaining a constant temperature and slightly humid environment on the wound surface can allow epithelial cells to crawl faster and reduce scar formation. Hydrocolloids and foam dressings commonly used in hospitals are developed based on this logic. ； Many primary care surgeons in the United States support the idea of ​​"prioritizing dry scabs". They believe that as long as shallow abrasions without obvious exudation are thoroughly debrided and exposed to a dry environment, scabs will form quickly, which can reduce the risk of bacterial invasion and eliminate the need to frequently change dressings and torment the patient. I myself encountered a child who fell on his knee in the clinic. If it is just superficial bleeding and no obvious tissue fluid leakage, the parents will usually ask the parents to go home and not apply a thick band-aid. As long as it is gently disinfected with povidone iodine once a day and not exposed to water, the scab will usually come off in three or four days, which is faster than covering it every day. If the wound is at a joint and has a lot of exudation, it is recommended to cover it with an absorbent dressing. There is no need to worry about which method is the "standard answer".

What many people don’t know is that wound care is never about just looking at the broken skin. To use an inappropriate analogy, the wound is actually like a delicate sapling. Just spraying fungicides on the leaves is useless. The soil, fertilizer, and sunlight must keep up with it to grow well. Not long ago, our department admitted an old man who had been bedridden for a long time after a cerebral infarction. He had a three-centimeter stage III pressure ulcer on his sacrococcygeal area. At first, his family members came to urge him every day, "Please give me some good medicine so that the wound can heal quickly." However, it took us three days just to adjust the turning plan and teach the family members how to supplement protein for the old man. If we don't solve the problem of long-term pressure and don't replenish the old man's albumin, even if we use the most expensive dressing every day, the wound will not heal. There are also guidance on wearing pressure garments in the scar stage after burns, lymphatic reflux care for wounds that do not heal due to lymphedema after breast surgery, and pressure-reducing shoe adaptations for diabetic foot patients. These things that seem to have nothing to do with "applying medicine and bandaging" are all within the scope of wound care.

There was a young girl who had a mole removal operation before. After removing the sutures, she felt that the wound care was over. As a result, she ran and jumped every day and pulled the wound. In the end, the scar grew larger than the original mole, and she came back for scar removal treatment. In fact, tension reduction care and sun protection three months after the operation are also very important parts of wound care, but many people are not aware of this.

To put it bluntly, the definition of wound care is a long list of professional expressions, but in reality it means "following the specific person and specific wound." There is no one-size-fits-all process. As long as the patient can suffer less and have a good recovery effect, it is the right care.