Top Tips for wound care:
- First Aid: Stop the bleeding, Clean it, Cover it!
Minimise risk of infection by first washing your hands. Stop the bleeding by applying pressure, and remove as much debris as you can from the wound. Running water or saline can be used to flush the wound. Cover the wound with a sterile dressing or plaster, and continue to apply pressure and elevate. If there is any skin flap evident in the wound, it is best to try and lay the skin back over the skin. The tissue may reattach and improve wound healing. It is not advised to try and remove the skin flap, particularly in full thickness skin injuries – if in doubt leave it in place. If the wound is deep, it may need stitches and it is best to see your GP.
- Don’t over wash
After the immediate first aid flush, it is not necessary to continue to vigorously wash the wound – once a day is sufficient. Washing too frequently may irritate the injury and delay wound healing.
- Over the counter antiseptic
Use an over-the-counter antiseptic as part of your first aid – whether it be fluid, powder or ointment. Most critically, read the instructions and apply as advised. Applying concentrated ‘neat’ antiseptic will produce unnecessary pain and burn the vulnerable tissue of the wound.
3 Common Misconceptions:
“It’s red – it must be infected!”
Localised inflammation is a normal at wound site, and is a sign of a healthy immune response. Immediately following a cut or abrasion, the small blood vessels dilate at the injury and increase blood flow. The capillaries become more permeable, and white blood cells flood the area and begin to digest microorganisms and foreign material. Signs of inflammation include heat, swelling, redness and pain. The increased blood flow and cellular activity creates redness and warmth, and the increased fluid will cause the area to swell. Nerve endings become sensitive, and this is a protective response from the body telling you to be careful of the area. Acute inflammation is a signs that your immune system is kicked into action, and should only last a few days.
It is important to note that inflammation can be present without infection, but if an infection develops it will often also be inflamed. Signs of infection including increased heat and pain (getting worse, not better), red streaks extending from the wound, pus or exudate and fever. If in doubt, seek medical help.
“I need a healthy scab – it should dry out.”
Current health science recommends moist wound healing as best practice for skin injury. A moist environment promotes skin growth and migration of new cells, and ensures essential proteins are available at the wound site. A hard scab at the wound surface makes it difficult for cellular fluid to carry growth factors and proteins around the wound, and significantly delays the healing process and increases scarring. Don’t confuse moist wound healing with moist dressing – if the skin is soggy and macerated, or the fluid is weeping through the dressing this indicates more frequent wound change is necessary. The pharmacy will have a range of dressings for wet wounds (hydrocolloid, foam). However, increased exudate may also be a signs of infection. If in doubt, seek medical help.
“Wound licking – Just don’t…”
Likewise with old-wives tales of onion skin, vinegar, garlic… Some of these methods have valid scientific evidence. For example, there is strong evidence that our saliva contains a blood clotting factor to stem small bleeds. Lysomzyme is an enzyme known to attack gram positive bacteria and is also present in our saliva. But the risk of introducing harmful bacteria from our mouths is far greater! Vinegar contains acetic acid and can be useful against pseudomonas aeruginosa bacteria, and both gram negative and gram positive bacteria however must be used at correct concentration or it may cause unnecessary pain and tissue injury. Honey is a traditional treatment with proven action against gram negative and gram positive bacteria. At the correct dilution, honey has hydrogen peroxide activity, and due to its high sugar content produces an osmolarity that inhibits microbial growth. But not all honey will work! Medical grade honey (Manuka) is available, and sterile dressing impregnated with honey can also be prescribed – supermarket products will only cause a mess and great disappointment. Ask your doctor or wound care professional for advice to ensure your treatments are effective.
Lisa MacRae is an experienced podiatrist, working in private practice in Melbourne. Lisa has an extensive work history in diabetic foot health, and while her experience is with foot injury (amputation, ulceration, gangrene – the fun stuff!) the principles behind wound healing are applicable to the body more widely as well. 85% of lower limb amputations are preventable – get your feet checked!