Purpose of wound care

Minimizes the risk of infection and deterioration, minimizes scarring and functional impairment, and minimizes discomfort during the healing process.

Last week, I was working at a community wound clinic and met a lady in her forties. There was a red hyperplasia scar on the index finger of her left hand. It was difficult to bend her fingers. He said that he got a cut of more than one centimeter while cutting vegetables half a month ago. He flushed and put a band-aid on it at home. He covered it up in panic the next day and took it off. He exposed it to water every day. He said that the older generation said, "The scab will fall off as soon as it is dry." However, within two days, an abscess developed and turned into a small radish. It took a long time to stay and left a scar. Now it hurts to pinch a kitchen knife.

Speaking of this, I have to mention the debate between "dry healing" and "wet healing" that everyone is arguing about now. Many people think that it is either completely open or completely covered. In fact, there are applicable scenarios for both sides. I usually tell patients that if it’s just a scratch on the surface of the skin with little oozing, it’s okay to leave it open if you find it uncomfortable to stick something on it. ； However, if it is a clean wound that is deep into the dermis and has obvious exudation, using a sterile dressing to maintain a moist environment can heal nearly one-third faster, and the probability of scarring is much lower. However, if it is an infected wound that oozes yellow pus and a lot of exudate, if you still cover it, it is creating a breeding ground for bacteria. You must first open it for drainage and wait until the leakage is reduced before considering closing it.

Don't think that infection is a trivial matter. When I was rotating in the general surgery department, I met a 72-year-old diabetic man. He wore new shoes and developed a small blister on his heel. I squeezed a band-aid on at home and didn't take it seriously. After a week, the entire foot was swollen. When he came here, the ulcer had rotten to the Achilles tendon. In the end, he had to amputate half of his toe to save his leg. For people with diabetes, varicose veins of the lower limbs, and people with low immunity, a wound as large as a needle tip may develop into gangrene that requires amputation if not properly cared for. At this time, the core of care is to strangle the signs of infection. Not only must the wound be debrided, but the underlying disease must also be controlled and the local pressure adjusted. Otherwise, it is useless to just disinfect the wound.

Once the risk of infection is under control, the next focus of care will be on "whether it can be used after it has grown." Two months ago, a little girl fell while riding an electric scooter and bruised a large piece of her elbow. During the recovery process, she was afraid of the pain and did not dare to move her arm. She froze her arm every day. When the scab fell off, she found that her arm could not be bent at 90 degrees. It took almost a month for rehabilitation to recover. There are also many people who have injuries on their faces. They do not pay attention to sun protection during care and do not need to remove the stickers. They end up with raised red scars. Spending tens of thousands of dollars on laser may not completely eliminate them. In fact, if they pay more attention to the healing process, most of these problems can be avoided.

Of course, when nursing, we cannot just focus on "getting better quickly and leaving no scars" and ignore the patient's feelings. There was a five-year-old child who burned his arm with boiling water. At first, the parents were afraid of the side effects of using analgesic dressings. Every time the dressing was changed, the child could be heard crying on the whole floor. Later, we changed to a hydrocolloid dressing, which hardly stuck to the new granulation. The child was not in so much pain and did not resist the dressing change, and the recovery speed was much faster. After all, the healing cycle can be as short as three to five days or as long as several months. If every care is like torture, ordinary people will not be able to persist, let alone children.

To be honest, I have been doing wound care for almost ten years. I have met too many people who treat wound care as a trivial matter. They either just apply some red lotion and ignore it, or they peel off the scab every day to see if it has healed. Instead, the wound that could have grown well will become scarred or even infected. In fact, to put it bluntly, wound care has never been a "step-by-step" standardized process. It has to be flexibly adjusted according to the condition of the wound and the person's physical condition. The ultimate goal is to save you from suffering. After you recover, you will be the same as when you were not injured, and you don't have to regret a small wound for a lifetime.