Correct wound care concepts

Moisturizing and repairing, layered to deal with acne.

Last week, I just treated a little girl who was a sophomore in high school. She fell off her knee while riding a bicycle. I was afraid that her parents would tell her when I got home. So I took out the red liquid at home and applied it twice. After letting it dry for three days, a hard black scab formed. I thought it was almost healed, but it hurt when I pulled it when I walked. Yellow pus also oozed out. When it came, the scab was as hard as a plastic shell. When it was removed, the little girl cried so much that even the nurse felt soft. The superficial scratches should have healed in a week, but in the end, a dark brown pigmentation was left, which took more than half a year to disappear.

Speaking of which, the field of wound care has been quarreling for almost half a century, and now the two mainstream views have their own applicable scenarios: Most of the older generation of clinicians agree on "dry therapy", which is to expose the wound after disinfection and rely on the scab to form a natural protective barrier. The operation is simple and it is not easy to cause infection. In the early years when medical supplies were insufficient, this was indeed the most cost-effective treatment method. Nowadays, many grassroots hospitals still use exposure therapy to control infection first when dealing with wounds with heavy pollution. However, after the concept of wet healing became popular in the past 20 years, a large amount of clinical data has confirmed that as long as thorough debridement is done, the migration speed of epidermal cells in a moist sterile environment is twice that of a dry environment. This can not only reduce secondary damage caused by pulling hard scabs, but also reduce the probability of scarring by at least 50%.

Don't think this is a "new gimmick of Western medicine". The last time I cut vegetables, I cut my left index finger. The incision was so deep that I could see the subcutaneous fat. I immediately used liquid cold water for 3 minutes to squeeze out a small amount of blood contaminated by the kitchen knife. I only used iodophor to remove 2% of the wound area. centimeters of skin (splashing it directly on the wound will kill the new granulation tissue, which is completely unnecessary), and then put a waterproof hydrocolloid dressing on it. It was not changed or "uncovered for ventilation" in the middle. It was completely healed in three days, and now there is not even a mark left. If my mother's treatment method had been applied, she would have put a band-aid on it and changed it every day, and she would have to remove it from time to time to dry it, and it would have scabbed and left scars long ago.

Of course, not all wounds are suitable for suffocation, such as deep holes dug by rusty iron nails, or wounds that are seriously contaminated by dirt and have suppurated. Don’t think about whether wet healing will leave scars first. Go to the hospital for debridement and tetanus as soon as possible. The primary goal at this stage is to control the infection. Whether or not scars can be left is another matter. As for wounds on the mucous membrane, such as cuts on lips and abrasions on the perineum, do not rub them with povidone iodine. Too much irritation will delay healing. Rinse them with normal saline and apply some mild erythromycin ointment.

What troubles me the most is that many people are superstitious about "family remedies", such as sprinkling amoxicillin powder, Yunnan Baiyao, or even toothpaste and soy sauce on the wound. Really, messy powder sprinkled on the wound is equivalent to setting up a natural breeding ground for bacteria. It was originally just a small scratch, but many people ended up with infection under the scab. When the doctor came to debridement, the doctor had to dig out the powder embedded in the flesh bit by bit, and the patient suffered a lot.

There are also many people who think that "scabbing means they will be healed soon", but in fact, hard scabs are the culprit of scarring. There used to be a boy who loved to play basketball. After he fell on his elbow, he couldn't help but pick at the scab. It broke and knotted again. He repeated it three or four times and finally developed a keloid the size of a peanut. Every summer, it was itchy when he sweated. He had to take hormone injections regularly to control it. To put it bluntly, if the scab is soft, not red or swollen around it, and does not hurt when you press it, don’t touch it and just wait for it to fall off on its own. ； If the scab is as hard as a rock and hurts when pressed, or even yellow-red exudate oozes out from the edge, then there is a high probability that the scab is infected. See a doctor for treatment as soon as possible instead of removing it by yourself.

In fact, is there any nursing formula that is universally applicable? They are all adjusted flexibly based on the specific conditions of the wound. For shallow injuries, priority should be given to reducing scarring, and for deep injuries, prevent infection first to ensure safety. Don't believe in those "universal care tutorials" on the Internet. When you are really unsure, go downstairs and see a surgeon at a community hospital for a look. It is much better than trying to figure it out at home for three days.