Wound care definition

Supported by evidence-based medicine, it targets different types and stages of skin and subcutaneous tissue injuries, covering the entire process of debridement, infection prevention and control, healing and matching, functional restoration, and complication prevention. The ultimate goal is to restore the physiological function of the affected area to the greatest extent and reduce the risk of scars and sequelae. It is by no means a simple operation of "applying iodine and applying a Band-Aid" as popular perception.

Speaking of which, I just met a young man in the surgical clinic last week who fell on his knee while riding an electric bicycle. When he came in, his trouser legs were rolled up, and there were yellowish-white pustules under the thick scabs. When pressed, he gasped in pain. He was also particularly aggrieved, saying that he applied iodophor three times at home every day and deliberately left it to dry without touching the water. Why was it getting worse? In fact, it is a typical definition of wound care that is narrow: he only disinfected the surface and did not notice that there was a lot of exudation on the scratched surface. Leaving it open to dry made the epidermal cells unable to crawl, and the hard scab sealed the exudate and could not drain it out, directly causing infection.

Speaking of which, I have to mention the differences of opinion that have been quarreling in the field of wound care for almost half a century. In the early years, the traditional school advocated dry healing. It was considered that the wound should be kept dry and scabbed. Many elders still hold the concept of "the wound should be left to dry and not covered". This is actually a continuation of this idea. It was not until Dr. Winter confirmed through animal experiments in the 1960s that the migration speed of epidermal cells in a humid environment is twice that of a dry environment, and the idea of ​​wet healing gradually became the clinical mainstream, but this does not mean that dry care has been completely eliminated - For example, if there is a small scratch on the fingertip that is particularly superficial and bleeds very little, it is easy to get dirty when typing on the keyboard or holding things in daily life. Many primary care nurses will still recommend disinfecting with povidone iodine and then drying it. On the contrary, it is less likely to cause problems than putting on a Band-Aid. The two ideas are never either/or.

I have been in emergency surgery for almost 8 years, and I have seen too many people think that wound care only requires focusing on the "broken piece". What particularly impressed me was an old man with diabetic foot who was admitted to the hospital two years ago. He had an ulcer the size of a coin on the outside of his left foot. His family came here every day to ask why it was not getting better after a week of changing the medicine. In fact, it was not a problem with the medicine at all: the old man’s blood sugar on an empty stomach was 12mmol/L, half of the blood vessels in his lower limbs were blocked, and the blood supply could not reach the wound. No matter how much dressing was changed, it was in vain. Later, while we asked the endocrinology department to regulate blood sugar, we also asked the vascular surgeon to perform interventional blood vessel opening, and the wound slowly grew. You see, the scope of wound care has never been limited to the wound itself. The patient's underlying disease, nutritional status, and local blood supply are all factors that need to be considered.

To use an inappropriate analogy, wound care is actually very similar to partially renovating an old house: debridement involves cleaning up the collapsed bricks, rotten tiles, and rotten garbage first; infection prevention and control involves removing mold and insecticides from the entire space; and choosing dressings depends on the moisture level of the wall, whether it is putty or waterproof. Water paint, later pressure intervention, and scar care are all about soft decoration and trimming. You can’t just buy some materials and paste them on the broken areas. It depends on the type of the house (wound location), the degree of damage (wound staging), and whether the foundation of the house itself is strong (the patient’s basic physical condition).

Oh, by the way, the issue of "can a wound touch water" that has been particularly hotly debated on the Internet is essentially about different understandings of the boundaries of this definition. You said you can't touch it, but clean the surgical incision three days after the operation. In fact, rinse it with running warm water, dry it and disinfect it in time. There will be no problem at all. You can't not take a shower for half a month after the operation, right? You say it can be touched. For granulation wounds with thick scabs that have just been torn off, as well as infected wounds such as impetigo, contact with raw water will most likely aggravate the infection. There is no unified standard answer, and everything must be judged based on the specific situation.

Finally, there is a point that people often miss: wound care is never a one-sided job of medical care, and patient self-management is also a core component. Not long ago, I had an aunt who had a breast tumor removed. Every time I changed the dressing, I always warned her not to peel off the scabs by herself and not to apply aloe vera gel or folk medicine powder at home on the wound. However, when she got home, she felt that the scabs were sticking up and getting in the way. You said that in this situation, even if the doctors and nurses perform standard dressing changes every time, they can't afford to go home and mess around on their own, right?

In the final analysis, wound care sounds simple. In fact, it is a detailed job that depends on both professional ability and the cooperation of multiple parties. There is never a universal formula. Being able to provide the most appropriate solution for each person's situation is the core connotation of this definition.