Wound care measures

Clean the wound surface in time, maintain a suitable moist environment, and do a good job in infection prevention and control. More than 90% of ordinary acute wounds (including daily scrapes, shallow cuts, postoperative superficial recovery wounds, etc.) can heal smoothly by following these three principles, and there will be basically no problems such as abnormal scar hyperplasia and secondary infection.

Let’s talk about the controversy over cleaning first. There is quite a quarrel on the Internet right now. One group says that it is safe to use iodophor-alcohol for disinfection, while the other group says that it is enough to rinse with saline. Disinfection will damage the tissue. When I was rotating in the emergency surgery department, I saw too many people taking out the alcohol spray in their pockets and spraying the wounds on the wounds as soon as they fell. The children jumped in pain, and the adults thought that "disinfection only needs pain to be effective." In fact, the current mainstream consensus among international wound ostomists is that if it is only a superficial wound that is not stained with sediment or dirt, just use room temperature saline to clean the surface dust. There is no need to use irritating disinfectants. ； Only when the wound is stained by contaminants such as dirt and rust, low-concentration iodophor is needed to disinfect the area around the wound. However, irritating disinfectants such as 75% alcohol and iodine are not recommended for direct contact with open wounds. Last week, I met a young man who fell while riding a shared bicycle. I wiped the wound three times with alcohol at home. It was just abrasion of the epidermis. As a result, the surrounding healthy skin was irritated to the point of redness, swelling and blisters, and it took three days for the scab to form.

Oh, by the way, there is another misunderstanding that has been passed down for generations: wounds need to dry and scab to heal quickly. In fact, this is where traditional care and modern wet healing concepts quarrel most fiercely. People of the older generation always think that covering the skin is prone to pus, and leaving it to dry to form a hard scab is equivalent to "growing". In fact, a dry environment will cause the new epithelial cells to lose the moist environment for crawling, and it is easy to form hard scabs to suffocate the exudate underneath, which in turn increases the risk of infection. Last month I met a little girl who had a double eyelid surgery. Her mother told her to leave the wound to dry every day after the operation. On the third day, the scab was as hard as a small layer of armor. When the sutures were removed, she burst into tears. In the later stage, she still had light red pigmentation for almost two months. ； If she had applied a thin layer of erythromycin eye ointment or a special wound moisturizing gel every day for the first three days to keep the wound slightly moist, she would not have suffered this problem at all. Of course, not all wounds need to be covered, such as pressure sores and diabetic foot ulcers that exude a lot of fluid. Instead, highly absorbent foam dressings should be used to absorb the exudate in a timely manner. If the wound is stuffed too hard, it will soak the new tissue.

As for the prevention of infection that everyone is most concerned about, there is really no need to take cephalosporins and apply various folk remedies claiming to be "sterilizing and anti-inflammatory" as soon as you are injured. As long as ordinary shallow wounds are cleaned well and clean dressings are changed regularly, infection will basically not occur. Only when the wound remains red, swollen and hot for more than 48 hours, has yellow or green purulent secretions, or is even accompanied by fever, you need to take oral or topical anti-infective drugs as directed by your doctor. Not long ago, an aunt cut her finger while cutting vegetables. She put a Band-Aid on it for three days and did not change it. The wound turned white and pus oozed out. She took cephalosporins at home for five days. When she came to the clinic, we cleaned off the necrotic skin and replaced her with a breathable dressing for three days. It healed. Those five days of cephalosporins were purely in vain and increased the risk of drug resistance.

There are also some scattered practical experiences, which are accumulated from daily dressing changes: before the wound on the hand comes into contact with water, you can put a plastic wrap or waterproof band-aid on it, and remove it in time after washing to let it breathe； For frequently moved areas such as knees and joints, try to avoid making large movements to stretch the wound, otherwise the newly grown epithelial tissue will be easily torn. ； Never pick at the scab before picking it off. The probability of pigmentation increases by 30% once you pick it off. If you have scars, you can continue to apply silicone gel for 3-6 months after the scab is removed, which can minimize the risk of hyperplasia.

Finally, don’t be too superstitious about “one-size-fits-all care.” After all, everyone’s body constitution, wound depth, and contamination are different. If the wound is so deep that you can see the fat layer, your blood pressure won’t stop after ten minutes, or you are pricked by a rusty iron tool, don’t mess around at home. Go to the hospital first and see a doctor for treatment. Get a tetanus if it’s necessary. It’s more useful than reading a hundred popular science articles.