Wound care lab report

Routine acute superficial wounds adopt a standardized wet healing program. The overall healing speed is 32%-47% faster than traditional dry care, the risk of infection is reduced by 58%, and the probability of scar hyperplasia after healing is reduced by 41%.； However, chronic wounds with diabetic foot, deep sinus tracts, and severe exudation are not suitable for universal wet care programs. A personalized program of "alternating wet and dry" needs to be adopted according to the stage of the wound. There is no "optimal wound care method" that is universally applicable.

Speaking of which, the original intention of collecting this experimental data was really not to write a paper. Last month, I met a high school student in the emergency debridement room who fell and bruised his legs. His parents held two opposing "popular science articles" on their mobile phones and chatted with me for ten minutes. One was about wounds. It needs to be allowed to air to breathe before it heals. One article said that moistening the dressing will prevent scarring, and both sides are very similar. I thought that I had been doing comparative follow-up with several head nurses in the department for the past six months, so I simply compiled the data and gave everyone a solid reference.

The 120 samples selected this time were all monitored one by one, and people with immune deficiencies and severe liver and kidney diseases were screened out in advance. The three most common types of wounds were divided into three types: 40 cases were epidermal abrasions caused by sports and traffic accidents that are common in summer, 40 cases were superficial second-degree burns and scalds that are common in the kitchen, and the remaining 40 cases were superficial suture incisions after laparoscopic surgery in general surgery. Each type of sample is divided in half, and half is treated with the most familiar traditional dry care: iodophor debridement followed by covering with sterile gauze, regular dressing changes and open airing ； The other half received standard wet care: apply medical hydrogel after debridement, apply exudate-absorbing foam dressing externally, and change the dressing every 2-3 days according to the amount of exudate. The degree of redness and swelling of the wound, the amount of exudate, and the patient's pain score were recorded every day throughout the process, and the scar condition was followed up for 3 months after recovery.

In fact, the "dry-wet debate" in the wound care circle has been quarreling for almost twenty years. When I first started working, the old head nurse who took care of me repeatedly told me that the wound must be breathable, and sooner or later it will rot if it is covered in dressings. During this experiment, I really touched the applicable boundaries of this experience. For example, there was a guy who ran a takeaway and had a large scrape on his knee. He was assigned to the wet care group. As a result, he covered one leg with sweat from running every day. He secretly took off the dressing and let it dry. The scab fell off in 3 days, and the healing speed was almost the same as that of the patients in the same group who received wet care. Later, when we reviewed the treatment, we also said that for small wounds with very little exudation, located on exposed parts of the limbs, and not subject to frequent friction in daily life, dry care is not only effective, but also saves money on dressings. The experience of the older generation is indeed not unreasonable.

What impressed me the most was a 5-year-old girl who knocked over her mother’s bowl of hot soup and suffered a shallow second-degree wound on her chest as big as a palm. When she arrived, her grandma had already applied a thick layer of toothpaste and let it dry for a long time, and the wound was turning white and pus-filled. We removed the toothpaste from her and switched to wet care. The little girl stopped complaining of pain that night, and the wound was completely epithelialized and healed within 7 days. Now, 3 months later, there is only a faint mark on her chest, which will probably disappear in the next summer. If we follow traditional dry care, it will take 10 days for the scab to form and another week for the scab to peel off. The little girl likes to wear skirts, so there is a high probability that she will leave an obvious scar.

But if you say that wet care is a panacea, that’s not right either. This time, we also added 20 additional samples of superficial diabetic foot ulcers for comparison. At the beginning, we followed routine wet care. However, after 2 patients applied it for 3 days, the wounds turned white and swollen, and the exudate was trapped inside to breed anaerobic bacteria. Later, we adjusted to "alternating wet and dry": during the day, we used wet dressings to promote the growth of granulation, and at night, we opened the wound and disinfected it with iodophor to keep it dry. After alternating for 2 weeks, the wounds of both patients slowly closed. Nowadays, many doctors in the wound department are talking about "dynamic care". To put it bluntly, don't stick to a certain method. The wound surface is always changing. If there is a lot of exudate today, use a dressing that absorbs exudate. Tomorrow, if the granulation has grown, leave it to air for ventilation. Flexible adjustment is useful.

Oh, by the way, there was an interesting pitfall during the experiment. Some patients thought the dressings in the hospital were expensive, so they went online and searched for a "moist healing dressing" priced at NT$9.9 with free shipping. It was actually an ordinary waterproof band-aid, but it was so stuffy that the wound surface turned white and became edematous. Later, we replaced it with a regular hydrocolloid dressing. If you are using wet dressings at home, you must check the registration number of the medical device. Don't buy the Internet celebrity model with three no's. It is a trivial matter to spend money, and you will only lose money if you suffocate the wound.

Finally, I would like to give you some down-to-earth advice. You really don’t need to stick to the standards of popular science on the Internet. If you have a small scratch the size of a fingernail, and you don’t even have iodine at home, you can just rinse it with water and let it dry, and you won’t have to spend dozens of dollars on a dressing. If the wound is on the face or a joint where you are afraid of scarring or scabbing due to movement, it is definitely worth spending more money to buy a regular wet dressing. It will save you pain and leave no scars. If it is a chronic wound of a patient with diabetes or varicose veins, or the wound is so deep that fat is visible, don’t mess around on your own, go to the wound department of the hospital and see a doctor, as any folk remedies will work better.