wound care definition

Full-cycle care is carried out for various types of acute and chronic wounds, including accurate wound assessment, infection prevention and control, healing environment regulation, functional repair support, complication prevention and psychological counseling. The ultimate goal is to shorten the healing cycle, reduce the risk of scars and dysfunction, and maximize the restoration of the physiological function and appearance of the injured area.

Last week I met a 19-year-old high school student in the dressing room. He fell on his knee while riding a mountain bike and scratched a piece of skin about the size of his palm. I applied iodophor every morning and evening at home and covered it with thick gauze for three days. When I arrived, the entire wound was white and yellow pus had appeared on the edges. When I sat down, the first thing I asked was, "I've disinfected it carefully, why is it still not good?" ”, a typical cognitive misunderstanding that equates wound care with disinfection.

To be honest, when I first entered the general surgery dressing room, I felt that the job was not very technical. The teacher asked me to take photos of the wound, measure the length, width, and depth, and feel the edge temperature before each dressing change. I thought it was unnecessary until I met an old man with diabetic foot. His family insisted on leaving the wound to scab the old way, saying "it will rot if you cover it." As a result, pus accumulated under the scab, and half of the entire toe was black, and I realized that it was really not that simple.

There are actually still differences in the core concepts of wound care in the industry. Many clinical workers of the older generation adhere to the concept of dry healing, believing that keeping the wound dry and promoting scabbing can avoid infection. This idea was used in an environment with poor disinfection conditions and few dressing options a few decades ago. It has indeed helped many people avoid the risk of serious infection. Until now, many elders still say "let it dry and don't touch the water" when treating small scratches on their children. It is not unreasonable. However, the evidence of evidence-based medicine in the past two decades points more towards the concept of wet healing: keeping the wound surface moderately moist under sterile conditions can double the crawling speed of epithelial cells and allow autolytic debridement of necrotic tissue. This eliminates the need for hard scraping every time the dressing is changed, and the patient suffers less. Now when we deal with wounds such as deep abrasions, postoperative incisions, and pressure ulcers, we basically give priority to wet dressings such as hydrocolloids and foam dressings, and the recovery speed is indeed much faster.

But don’t think that dry care is totally wrong. A few days ago, a mother came with her child and got a small blood blister on her finger caught in the door. It didn’t break, so I just let her go home and let it dry without even applying any medicine. This kind of superficial injury without an open wound should be treated as conveniently as possible, and there is no need to use dressings that cost tens of dollars a piece.

Many people think that wound care only concerns the wound itself. In fact, it is not the case. Last time, an aunt who had liquefied fat from the incision after surgery came to change the dressing every day, and it didn't last for a week. Later, when I asked her, I found out that she drank white porridge every day at home, which was not enough protein supplement. Later, she was asked to eat two eggs and a glass of milk every day, and fresh granulations grew in three days. You see, nursing also has to take care of food. There are also patients with scars after burns who need elastic band compression and rehabilitation training to prevent joint adhesion in the later stage. These are all within the scope of wound care, and it does not end after the scabs fall off.

In fact, if you ask doctors and nurses from different departments about the definition of wound care, the answers may be different: Orthopedic nurses will first mention how to bandage without affecting the movement of the affected limb or pulling on the incision.； The first thing doctors in the burn department think about is how to preserve the remaining epithelial tissue and reduce the risk of infection. ； The first reaction of the medical staff in the endocrinology department is how to improve the circulation of the lower limbs and prevent the wounds from getting deeper and rotten. No one's answer is the only standard. In the final analysis, good wound care is care that can save patients a few days of pain, leave fewer scars, and allow patients to return to normal life as soon as possible.