Understanding Wound Care Needs

Types of Wounds: Acute Wounds vs Chronic Wounds

Acute wounds or fresh wounds include minor cuts, scratches, lacerations, abrasions, insect bites, and surgical wounds. They usually heal within a predictable time frame and follow the normal wound-healing process.

Chronic wounds include venous leg ulcers, chronic pressure ulcers, other pressure injuries, diabetic foot ulcers, radiation wounds, deep burns, and skin cancers. They are caused by diabetes, vascular conditions, the use of certain medications, or prolonged mechanical pressure. A chronic wound can take weeks or months to heal or may never heal.

Normal Wound Healing Process

The normal healing process in a wound involves the following stages:

Hemostasis: This is the first phase of wound healing which occurs immediately after an injury to stop bleeding. The body does this through vasoconstriction (narrowing of blood vessels in the area), formation of a platelet plug, activation of coagulation factors, and formation of a blood clot.
Inflammation: The next phase of wound healing is the process of inflammation. It causes wound pain, redness, swelling, and warmth. White blood cells, growth factors, nutrients, and enzymes enter the wound within the first 24 hours to fight bacteria, prevent infection, and prepare the wound for new tissue growth.
Proliferation: The proliferation or granulation phase of wound healing begins about 3 to 10 days after an injury. It involves the formation of granulation tissue and restoration of the vascular network. Fibroblasts and endothelial cells are the main cells involved in the proliferative phase.
Remodeling: The remodeling or maturation stage is the final phase of wound healing. It can last for weeks, months, or even years and involves collagen synthesis, tissue regeneration, formation of the extracellular matrix, formation of new blood vessels, wound contraction, and scar tissue formation in the affected area.

Types of Wound Healing

Healing by primary intention is when the wound edges are closed with surgical stitches or tapes. There is minimal loss of tissue, and such wounds heal with a thin, neat scar. Healing by secondary intention occurs in large wounds with more extensive tissue loss. The healing process is more complex, and such wounds heal with a larger, more noticeable scar.

In surgical wounds, primary closure involves closing the skin at the end of the procedure. Secondary closure involves leaving the wound open at the end of surgery and allowing it to heal by granulation and contraction.

Factors That Can Prevent Wound Healing

There are many factors that can impede wound healing, including:

Necrotic Tissue: Dead skin, foreign bodies, and debris in wound cavities can prevent wound healing.
Hemorrhage: Continued bleeding can keep the wound open.
Mechanical Stress: Constant pressure and friction on a wound and surrounding skin can affect its ability to heal.
Environment: Skin cells and immune cells need a moist wound environment to work. Dry wounds can take longer to heal.
Infection: When a wound has infected tissue, the body uses resources to fight the infection instead of healing the wound.
Age: Older people tend to have slower healing wounds.
Nutrition: Certain nutrients such as proteins, vitamin C, and zinc are needed to help wounds heal faster. A diet lacking these nutrients can lead to poor or delayed wound healing.
Chronic Conditions: Medical conditions such as diabetes, hypertension, peripheral vascular disease, and obesity can lead to delayed wound healing.
Medications: Certain medications can interfere with the way a wound heals.
Lifestyle Factors: Smoking can impair the body’s healing process and increase the risk of complications.
Chemical Stress: Some antiseptics and cleansing agents may damage healthy tissue and cause setbacks in the healing process.

Initial Wound Assessment

Most minor wounds heal on their own with first aid, without requiring any specific treatment. However, a chronic wound needs to be evaluated and treated by a healthcare provider.

Your healthcare provider will perform a comprehensive assessment to identify the cause of the wound so that the causative factors can be controlled. For instance, if you have a diabetic foot ulcer, they might adjust your diabetes medications for better blood sugar control and/or refer you to a podiatrist to prevent more diabetic foot ulcers. If you have a leg ulcer due to varicose veins, your provider may offer treatments such as compression stockings, sclerotherapy, vein stripping, etc., in addition to wound treatment.

Treatment of Wounds

There is a wide range of treatment options for wounds depending on the nature of the wound and your health status. In general, medical care for wounds includes:

Gently clean a fresh wound to remove dirt and debris by placing it under running water or dabbing it clean with a sterile gauze soaked in saline.
Performing surgical exploration of deep wounds under local anesthesia to remove dead skin and/or foreign bodies.
Closing a large wound with stitches or staples.
Dressing the wound, usually with dressings that help to keep the wound moist, for example, hydrofiber dressings or hydrogel sheets.
Prescribing antibiotics, if needed, to prevent infection.
Taking over-the-counter or prescription pain relievers to manage wound pain.
Reviewing other medications that could potentially affect the healing process.
Using compression therapy (support stockings) and other aids for promoting wound healing.
Vaccinating for tetanus after traumatic injuries.
Treating other medical conditions, such as diabetes or anemia, that might delay or prevent wound healing.
Recommending surgical treatment, such as vascular surgery or skin grafts, to promote healing or perform wound repair.

Special Considerations for Chronic Wounds

Care for chronic wounds involves removing dead tissue, applying dressings that maintain a moist environment, treating wound infections, and performing surgical procedures to restore blood flow to the wound site.

Surgical Debridement

Surgical debridement involves the removal of necrotic tissue (dead tissue) from a wound. It is done by a healthcare professional using tools such as tweezers or a scalpel. Enzymatic debridement uses enzymes to remove dead tissue from wounds.

Hyperbaric Oxygen Therapy

Hyperbaric oxygen therapy involves breathing in oxygen at high pressure in a special chamber. It can help with wound healing by increasing the amount of oxygen in the bloodstream.

Negative Pressure Wound Therapy

Negative pressure therapy, also called vacuum-assisted closure, helps wounds heal faster by using suction to remove fluid and bacteria from the wound. It is often used to treat complex wounds, such as diabetic foot ulcers, that are non-healing or at risk of not healing.

Therapeutic Ultrasound

High-frequency ultrasound treatments are delivered by physical therapists to create mechanical vibrations in the wound. This helps to reduce pain, increase blood circulation, stimulate collagen formation, and promote wound healing at a cellular level.

Skin Grafts

Skin grafts are a surgical procedure done to treat burn injuries and large wounds left behind after skin cancer removal. The treatment involves taking a piece of healthy skin from another part of the body and transplanting it to the affected area where the wound is present.

Skin Substitutes

There are various commercially available skin substitutes made from natural biological materials that are used for treating and managing chronic wounds. They promote wound healing by protecting the skin, preventing loss of moisture, preventing infection, and providing a biodegradable scaffold to support the growth of new skin tissue.

When to Visit Your Doctor or Hospital for Wound Care

Most wounds, such as minor cuts and scrapes, can be managed at home with first aid. However, certain wounds are more serious and require professional skin wound care and wound dressing materials to heal properly. Some of the signs that you should seek evaluation and treatment at your local ER or doctor’s office include:

Wounds that do not stop bleeding.
Deep lacerations or cuts where you can see underlying structures like fat, tendons, or muscles.
Animal bites.
Wounds showing signs of infection, such as increasing pain, redness, drainage, foul smell, fever, and chills.
Wounds that don’t show signs of healing within 2-3 days.
Minor wounds if you have diabetes or are immunocompromised (have a weakened immune system due to a medical condition or medications).

Diagnosis of Chronic Wounds: What to Expect at a Wound Care Center?

If needed, primary care providers can refer patients to professional wound care centers that specialize in treating deep, complex, non-healing, or difficult wounds.

Healthcare professionals will develop the appropriate treatment plan at a wound care center after performing a comprehensive assessment and diagnostic examination to identify the cause of your chronic wound, any complications from the wound, and any underlying conditions that could affect wound healing. The wound care team will also make a note of the type and size of your wound at the initial appointment to enable them to monitor your progress and response to treatment.

To diagnose and treat chronic or non-healing wounds, the wound care team will do one or more of the following:

Perform a physical examination to inspect the wound bed and check for blood supply.
Obtain a medical history, including chronic medical conditions, recent surgical procedures, and current medications to identify the cause of a chronic wound.
Order blood tests and urine tests.
Take a biopsy of the wound.
Culture the wound to look for any pathogenic (disease-causing) germs such as methicillin-resistant Staphylococcus aureus (MRSA).
Look for signs of infection that may require treatment with antibiotics and/or antimicrobial dressings.

Follow-Up Care

A wound is considered to be a chronic wound if it has not started healing after 4 to 12 weeks of treatment. Healthcare professionals regularly clean chronic wounds and cover them with special wound dressings and bandages. If a chronic wound still does not heal, special treatments such as negative pressure therapy or skin grafts are used.

In addition to caring for the wound and treating the underlying medical condition, people with chronic, complex, non-healing, and difficult wounds also require pain management and psychological support.

Self-Care Suggestions and Prevention of Complications

How to Clean a Wound

Applying Dressings and Bandages

Cover the wound with a bandage or gauze held in place with tape.
Change the dressing at least once a day or whenever it becomes wet or dirty.

Medications for Open Wounds

Quick Care for Minor Burns

Hold the affected area under cool running water for 10-15 minutes until it stops hurting badly, especially if it is a chemical burn.
Use cool water (but not ice) on the burned area. Ice can cause further tissue injury.
You can also place a clean cloth soaked in water on the burn or place the affected area in a cool water bath.
Apply a thin layer of petroleum jelly or antiseptic ointment on the burn.
Avoid using creams, lotions, or kitchen staples like oil, butter, or egg whites on the burned area.
Protect the area from friction by placing a sterile non-stick gauze (petrolatum or Adaptic-type dressing) over the burn. Make sure the dressing is lightly taped or wrapped. Do not use dressings that shed fibers. Change the wound dressing once a day.
Take an over-the-counter pain medicine to manage pain.

Caring for Surgical Wounds

Wash your hands with soap and water before touching the surgical wound. You can also use an alcohol-based cleanser.
Remove the old dressing. You may need to wet it to loosen it (unless your provider has told you to keep the wound dry).
Wash your hands again after handling the old dressing.
Clean the wound and the skin around it with a soft cloth or gauze pad soaked in mild soapy water or saline solution (salt water). Dab the wound lightly. Avoid rubbing it.
If your healthcare provider has asked you to irrigate the wound (wash it out), do so using a syringe to wash away any blood, drainage, or discharge. Pat the wound dry.
Do not use any lotions, creams, or ointments unless approved by your treating healthcare provider.
Place a clean dressing on the wound as instructed by your wound care team.
Clean your hands after finishing wound care.

Preventing Wound Complications

Keep the wound clean.
Cover the wound with a bandage or dressing to protect it.
Change the bandage daily or when it gets wet or dirty.
Avoid touching the wound.
Follow your healthcare provider's wound care instructions.

Frequently Asked Questions

What Are The Five Rules of Wound Care?

The five rules of wound care are:

Keep the wound clean.
Use appropriate dressings.
Change the dressing regularly.
Follow your doctor’s instructions for antibiotic use, if needed.
Seek prompt care for infected wounds.

Should a Wound Be Covered or Uncovered?

Evidence-based recommendations are that a wound should be covered to help it heal properly. A wound covering such as a bandage or dressing helps to keep the wound clean, maintains a moist environment, and prevents infection.

What Is The Best Thing To Put On a Wound For Healing?

The best thing to put on small cuts and scrapes to promote healing is petroleum jelly (Vaseline), aloe vera, or an over-the-counter antibacterial ointment. You should cover the wound with an adhesive bandage. If you are sensitive to adhesives, you can use a gauze pad secured with tape.

What Are The 4 Steps To Caring For a Wound?

Stop the bleeding.
Clean the wound.
Apply antibacterial ointment, petroleum jelly, or aloe vera.
Protect the wound with a dressing or bandage and change it regularly.

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