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Wound Care Introduction

A wound is a break in the skin (the outer layer of skin is called the
epidermis). Wounds are usually caused by cuts or scrapes. Different kinds of
wounds may be treated differently from one another, depending upon how
they happened and how serious they are.
Healing is a response to the injury that sets into motion a sequence of
events. With the exception of bone, all tissues heal with some scarring. The
object of proper care is to minimize the possibility of infection and scarring.
There are basically 4 phases to the healing process:
• Inflammatory phase: The inflammatory phase begins with the injury
itself. Here you have bleeding, immediate narrowing of the blood
vessels, clot formation, and release of various chemical substances
into the wound that will begin the healing process. Specialized cells
clear the wound of debris over the course of several days.

• Proliferative phase: Next is the proliferative phase in which a matrix or


latticework of cells forms. On this matrix, new skin cells and blood
vessels will form. It is the new small blood vessels (known as
capillaries) that give a healing wound its pink or purple-red
appearance. These new blood vessels will supply the rebuilding cells
with oxygen and nutrients to sustain the growth of the new cells and
support the production of proteins (primarily collagen). The collagen
acts as the framework upon which the new tissues build. Collagen is
the dominant substance in the final scar.

• Remodeling phase: This begins after 2-3 weeks. The framework


(collagen) becomes more organized making the tissue stronger. The
blood vessel density becomes less, and the wound begins to lose its
pinkish color. Over the course of 6 months, the area increases in
strength, eventually reaching 70% of the strength of uninjured skin.

• Epithelialization: This is the process of laying down new skin, or


epithelial, cells. The skin forms a protective barrier between the outer
environment and the body. Its primary purpose is to protect against
excessive water loss and bacteria. Reconstruction of this layer begins
within a few hours of the injury and is complete within 24-48 hours in a
clean, sutured (stitched) wound. Open wounds may take 7-10 days
because the inflammatory process is prolonged, which contributes to
scarring. Scarring occurs when the injury extends beyond the deep
layer of the skin (into the dermis).
Wound Care Signs and Symptoms
• Scrapes and abrasions are superficial (on the surface). The deeper skin
layers are intact, and bleeding is more of a slow ooze. They are usually
caused by friction or rubbing against an abrasive surface.

• Lacerations (cuts) go through all layers of the skin and into the fat or
deeper tissues. Bleeding may be more brisk or severe. Severe blows by
a blunt object, falls against a hard surface, or contact with a sharp
object are the most common causes of lacerations.

• Puncture wounds are generally caused by a sharp pointed object


entering the skin. Most common examples are stepping on a nail,
getting stuck with a needle or a tack, or being stabbed with a knife.
Bleeding is usually minimal, and the wound may be barely noticeable.

• Human bites and animal bites can be puncture wounds, lacerations, or


a combination of both. These wounds are always contaminated by
saliva and require extra care.
Physician Diagnosis
The doctor will want to know how the injury occurred, what home care you
did for the injury yourself before coming in, if you feel as if there is anything
in the wound, and when your last tetanus shot may have been.
You will be asked about your general health, present medications, and any
allergies to medications. Conditions such as diabetes, cancer, AIDS,
immunosuppression, sickle cell disease, and clotting abnormalities affect
wound healing. Steroids and chemotherapy drugs also interfere with wound
healing.
• If a hand or finger is involved, the doctor will want to see that you are
able to move the extremity or finger through its full range of motion.
There is a difference between not being able to bend or extend a finger
or not being able to do so simply because it is uncomfortable.
Sensation and circulation to the area will be tested carefully as well.

• If there is some suspicion of a foreign body in the wound or an
underlying bone break, an x-ray may be ordered.
Wound Care Treatment
• After careful examination and evaluation, the wound will once again be
cleaned.

• The area will then be numbed with a local anesthetic. This will allow a
deeper examination of the wound as well as repair without any further
discomfort. You may feel pressure, but no pain.

• If the wound requires stitches, it will be cleansed with an antiseptic


solution, and sterile towels or drapes placed over the area.

○ The doctor will wear sterile gloves and put in the stitches to bring
the wound edges together.

○ Once this has been accomplished, the area will be washed off
once again and a sterile bandage applied.

• You will be given further instructions regarding care of the wound.

○ Generally the bandage is kept on for 2 days. You should keep it


clean and dry, elevating it whenever possible to minimize
swelling and pain.

○ Over-the-counter pain relievers such as acetaminophen (Tylenol)


or ibuprofen (Motrin) are usually sufficient for any pain.

○ You will be told when the stitches need to be removed. Once


they are removed, small tapes may be applied over the wound to
lessen the stress on the healing wound and to lower the amount
of scarring, especially if on the face.

○ Use a sunblock (not a sunscreen) on the area for 6 months to


avoid discoloration from sun exposure.

• Bites may not be sutured unless a large area is involved or the bite
involves the face. Many of these become infected, so most doctors
prefer to leave them open for daily wound care. You usually will be
given antibiotics for bite wounds.

• Abrasions will be washed and scrubbed, if needed. It is important that


all the dirt and debris be removed because tattooing (permanent skin
discoloration) may result if this debris is left in the wound.
• Puncture wounds will require careful examination. If there is any dirt or
debris in the wound, the doctor may remove this small area so that an
infection does not occur.

Prevention
• Take care when using sharp objects such as knives, scissors, saws, and
trimmers.
• Wear shoes or boots on your feet.
• Use helmets when riding a bicycle.
• Use helmets, kneepads, wrist protectors, and elbow pads when using
in-line skates.
• Avoid picking up broken pieces of glass and handling razor blades.