Wound care health education

The core principle of wound care is to "control the sensation first, then promote healing and reduce irritation." There is no one-size-fits-all care plan for everyone. It needs to be flexibly adjusted according to the type of wound, healing stage, personal situation and physical condition. Wrong operation will prolong the healing time and increase the risk of infection and scarring.

Last week, a 19-year-old girl was admitted to the surgical clinic. She fell on her knee while riding a shared bicycle and lost a large piece of skin. She sprinkled Yunnan Baiyao powder at home and put on an airtight cartoon Band-Aid. It became so swollen that she couldn't walk in three days. When she arrived, her jeans were stuck to the pus that oozed out. When she tore them off, she shed tears from the pain. In fact, her wound was originally very shallow. As long as she protected it after debridement, it could heal in a week. This was because she had fallen foul of the common misunderstanding of "spreading medicine randomly and covering the wound".

There have been different clinical views over the years on whether wounds should be cured dry or wet. Traditional surgery prefers dry healing. It is believed that keeping the wound dry and scabbed can minimize the invasion of external bacteria and is suitable for people who need to move frequently and come into contact with complex environments.； In recent years, the field of chronic wound care has promoted wet healing. It is believed that in a humid environment covered by sterile dressings, granulation tissue grows faster and the probability of scarring can be reduced by about 30%. However, there is no absolute right or wrong between these two solutions. For example, if a delivery boy goes out to run orders every day, using ordinary gauze to heal the scratches on his legs is safer than being stuffed in a hydrocolloid dressing. ； If you are recuperating at home with a clean surgical incision, you will indeed get better faster with a moist healing dressing.

After talking about the controversy in the direction of nursing care, let’s talk about the most common disinfection misunderstandings that everyone makes. Many people think that iodophor is a "universal disinfectant" and they need to apply it three to five times a day to feel at ease when they are injured. Previously, there was a retired uncle Zhang who had a small cut of less than 1cm on his hand. He applied iodophor 8 times a day. The surrounding good skin was burned by the iodine and became peeling, red and swollen. The wound that was supposed to heal in three days took almost two weeks to heal. In fact, iodophor can only be used when debriding the wound for the first time or when the wound is stained with dirt. Repeated application of iodophor to a wound that has been cleaned and has no obvious leakage will kill the new granulation tissue and slow down the healing speed.

In addition to disinfection, the most frequently asked question is whether the wound can be exposed to water. Some people say, "Wounds should never be exposed to water." In fact, it depends on the situation. If you have a fresh wound or an infected wound that is still leaking pus, you must avoid sewage, otherwise it will easily aggravate the infection. ； But if the wound has grown new epithelium and the scab has begun to fall off, it is absolutely fine to take a shower and wash your hands normally. After washing, just use a clean cotton towel to gently dry it. On the contrary, it is safer than covering it and sweating all the time. Last time, a young man was afraid that his wound would come into contact with water. He didn't dare to take a shower for half a month in the summer, and he developed eczema around the wound, which was actually more uncomfortable than the wound itself.

In the end, what everyone is most concerned about is whether there will be scars and what can be used to remove them. First of all, it must be said that if you have scars, even a small opening as big as a needle tip may cause keloids. In this case, it is best to seek intervention from a dermatologist when the wound has just healed. Applying any scar removal cream yourself will not be of much use. If you are a person with an average constitution, do not apply scar removal cream on the wound while it is still bleeding. You must wait until the scab has completely fallen off and the wound has completely healed before applying it, otherwise it will easily irritate the wound. There is also the rumor that "eating soy sauce will leave black scars" that has been rumored for many years is completely nonsense. Last year, I had a minor surgery. I ate braised pork ribs every day, and the wound did not turn black. On the contrary, many patients who did not pay attention to sun protection during the healing period developed pigmentation. Therefore, applying sun protection three months before the wound heals is much more effective than avoiding soy sauce for 100 days.

I have been in the emergency department for almost six years and have seen too many strange ways of treating wounds: those who apply toothpaste, those who apply incense ash, and even those who sprinkle cephalosporin powder on the wound. This is not to say that these remedies are completely useless, but most of them are only suitable for very superficial, completely clean small wounds. If the wound is deep, stained with sand and rust, or scratched and bitten by a cat or dog, don’t mess around at home. Debridement should be done, tetanus should be used, and rabies vaccine should be given. If the wound remains red, swollen and painful for more than a week, and continues to ooze pus and does not heal, seek professional treatment as soon as possible. Don't turn a small problem into a big trouble.