A wound is a break in body tissues. Open wounds may be caused by cuts from sharp objects and since they break the skin, may cause infection and therefore need antibiotic therapy or anti-tetanus depending on the severity and cause. However, a closed wound may not break the skin (like a black eye) but can damage the organs near it.
Wounds may be accompanied by swelling and inflammation or may bleed excessively. An infected wound has pus while a contaminated wound contains foreign or infected material that needs to be cleared out before closing with either a bandage or by suture.
Mostly, a deep cut that needs stitches should be repaired within 6 hours after injury while those in the face or scalp can wait up to 24 hours. Stitching is needed when a cut is deep, jagged or longer than a half inch. Anti-tetanus shot is needed when the victim did not have the vaccine for the last 5 years.
Unbroken blisters may be left uncovered but if the area is prone to rubbing like the sole of the foot, it should be cushioned with a soft dressing or blister protection strips. If blister is broken, drain then cover with a non-stick dressing.
Some types of minor wounds:
Abrasions- scraping of the superficial layer of the skin, bleeding is usually limited.
Incisions/Lacerations- a cut or tearing of soft tissues involving deeper layers of the skin. Bleeding is rapid.
Punctures/Avulsions – those that cause small holes from nails, needles or animal bites. External bleeding may be slight but internal bleeding may result to damage of internal organs like those of gunshot wounds. There is danger of tetanus.
What to do with minor wounds:
1. Sanitize the hands then wear gloves.
2. Stop bleeding by applying direct pressure using sterile gauze.
3. Clean the wound using cool running water and soap to remove the debris and prevent infection. Antiseptic wipes or saline water may be used in cleaning.
4. Apply antibiotic cream.
5. Keep the wound moist to facilitate healing.
6. Wrap with appropriate bandage to keep the wound from rubbing against the cloth and dirt and bacteria.
7. Sanitize the hands.
Wound Dressings
A wound dressing is an adjunct to wound care which aims to promote healing and prevent further harm.
Characteristics of an ideal dressing:
Absorbent
Protective
Sterile, non-toxic, non-allergenic
Allows exchange of fluid and gas
Types:
Traditional Gauze pads - they can stick to the wound surface and disrupt the wound bed when removed, should only be used in minor wounds or as secondary dressing.
Tulle - does not stick and is used in flat, shallow wound and sensitive skin.
Semi-permeable film - for shallow wounds with low exudate.
Hydrofilm® is indicated as a primary or post-operative dressing to protect and cover non-exuding wounds, or as a secondary dressing for fixation.
Hydrofilm® Plus is a post-operative dressing with a highly absorbent wound pad, to protect exuding wounds.
Can stay for up to 6 days
Hydrocolloids - turns into a gel when exudate is absorbed. It provides an ideal environment for the formation of granulation tissue, particularly for the activity of fibroblasts, accelerating the healing process. It also facilitates debridement by promoting autolysis. High absorption capacity rapidly and reliably binds away excessive exudate, extending dressing change intervals. Can be left for up to 7 days depending on the type of wound. Protects wound from moisture and bacteria. Allows free passage of gases and moisture vapour
Suitable for second degree burns, abrasions, pressure ulcers, chronic and slow healing ulcers
Atrauman Ag is suitable for deep wounds. It is water repellent and impregnated with neutral triglycerides and coated with metallic silver. It avoids adherence to the wound, provides care for the surrounding skin and the silver is bactericidal only when in contact with bacteria.
Indication: for critically colonised and infected wound.
Wound Closure Strip – Indicated for atraumatic closure of minor wounds and surgical incisions; to protect wound margins against tension; to stabilize fresh scars and to provide wound support following early suture or staple removal.
Omnistrip is made of non-woven fiber, hypoallergenic, can be removed without pain and residue and can reduce scarring without suture and stapler.
Elastoplast Spray Bandage – provides instant protection against dirt and bacteria. Only used for minor wounds where bleeding is limited or has been stopped.
Surgifix is a tubular elastic net bandage for shoulder, knee, leg and foot is available in different sizes to hold dressings in place on any part of the body. It is an open mesh bandage which is quick and easy to apply and permit to be re-dressed without complete bandage being removed. It is comfortable and holds the dressing firmly in position and permits maximum ventilation with minimum restriction. It can be washed and re-used.
Size 1-2: for hand, wrist, arm & elbow
Size 3-4: for knee, leg, foot & shoulder
Size 5-6: for head, hip, thigh & axilla
2. Proliferation phase - collagen are built to replace the damaged tissues. The blood vessels provide oxygen and nutrients for these new granulation tissues. A red or pink color indicates a good supply of which. Dark granulation tissue indicates poor perforation or infection. Epithelialization takes place wherein epithelial cells resurface the wound. Usually lasts until day 21.
3. Maturation phase- the wound finally closes.
Supplementation in Wound Healing:
Protein and fatty acids- They help repair damaged tissues and support healing.
Vitamins A, C and E – needed for fast wound healing and to make collagen in the skin. Helps to create new blood vessels, fight infection and prevent permanent scars.
Zinc – a mineral that helps the body synthesize protein and make collagen.
Hydration is important for wound healing to facilitate proper circulation and detoxification.
Burns may be caused by heat, fire, radiation, sunlight, electricity or chemicals.
1. First degree burns are red, painful and swelling. Usually heal in 3 to 6 days.
Treatment: Soak the burn in cool water for at least 5 mins. Apply Aloe vera gel or antibiotic ointment. Wrap with a dry gauze bandage around the burn to keep off the air. Give pain reliever like Paracetamol, Ibuprofen or Naproxen.
2. Second degree burns are thicker and produce blisters. The skin looks very red and swollen. It takes 2 to 3 weeks to heal.
Treatment: Soak in cool water for 15mins. Apply antibiotic ointment and cover with dry non-stick dressing. Check the burn everyday for signs of infection like increased pain, redness, swelling or pus. Avoid breaking the blisters. Itching is a sign of healing, prevent scratching to prevent infection. Advise to apply sunscreen because the burned area will become sensitive to sunlight for months or a year.
3. Third degree burns cause damage to all layers of the skin. These may cause little or no pain because the nerves and tissues in the skin are damaged.
Treatment: Advise patient to go to hospital right away. Do not wash or soak or apply ointment. The burned area may be covered with sterile gauze until medical assistance is received.
Antihistamines may be suggested to reduce itching.
Calamine lotions or aloe vera gels may be applied to help soothe the burned area.
A scar replaces a damaged skin after a wound or surgery or from an infection like chickenpox or acne.
Treatment:
Dermatix Silicone Gel – Apply 2x a day for at least 2 months.
Scar-off Silicone Gel Membrane – Self-adhesive and may be used for a month, may be washed with pure water daily and reused when dried. Cut according to scar size and let adhere to a previously cleaned scar.
Dr Max’s Scar Treatment – Adhesive strip, can stay for four days and may be used during shower. Replace when it loses adhesiveness.
Hiruscar Gel – contains Allium cepa, aloe vera, allantoin and vitamins E and B3.
Madecassol Cream 1% - contains Centella asiatica and Lavender essence
Apply 1-2 times daily to the scar site.
IKBB Scars and Lighten Spots – contains Hydrolysed elastin, Hyaluronic acid, Primrose oil, Rosehips oil.
Apply several times daily.
- Course creator: Lurdes Pastor
- Course creator: Eliana Sequeira
- Course creator: Molly WONG