Wound care is the treatment of breaks in the skin or mucous membranes. Wounds can be caused by a wide range of circumstances including cuts, punctures and burns.
Common types of wounds caused by trauma, such as cuts and scratches, usually heal quickly without complications. They are treated by controlling bleeding, cleansing and covering the wound, and by applying a topical antibiotic ointment.
However, some people develop chronic (ongoing) wounds that are resistant to healing due to illness, surgery and other factors. It is important to learn to recognize a chronic or non-healing wound and to seek prompt medical attention for it.
The most common types of chronic wounds include pressure ulcers (bed sores), diabetic wounds and surgical wounds. If not treated properly, chronic wounds can have serious complications, including infection that spreads to other areas of the body, such as the heart's lining (endocarditis) or joints (septic arthritis).
Before treating a chronic wound, a physician may perform a physical examination, and collect a medical history and list of current medications, to determine why the wound is not healing properly. Chronic wounds are treated in a variety of ways, including antibiotic therapy for infections that may be slowing the healing process, irrigation to keep the wound clean and to prevent infection and the application of growth factors (proteins that stimulate cell growth) to the skin.
About wound care
Wound care is the treatment of breaks in the skin or mucous membranes. There are many different types of wounds caused by a variety of circumstances. Some common types of wounds, which are usually caused by trauma or injury, include cuts, scrapes, lacerations, puncture wounds and burns.
When treated properly and promptly, these types of wounds usually heal quickly without complications. If complications occur, they may include extensive blood loss, infection or injury to deeper structures, such as the nerves, tendons or blood vessels. Additional complications may result from foreign material remaining inside a wound.
Some people develop chronic (ongoing) wounds due to illness, surgery or other factors. These wounds may not heal or may heal slowly. They are often difficult to manage and require special treatment techniques.
The most common types of chronic wounds include:
Diabetic wounds. Foot lesions are a common complication of diabetes and sometimes require hospitalization and, in severe cases, amputation (surgical removal of the affected limb).
Bed sores (also called pressure sores or pressure ulcers). Areas of damaged skin and tissue that develop when sustained pressure, usually by a bed or wheelchair, cuts off circulation to parts of the body, especially the skin on the buttocks, hips and heels. Without adequate blood flow, tissue dies. Patients who are bed ridden or paralyzed are especially prone to bed sores, which can become infected if not treated properly.
Surgical wounds. After surgery, wounds may be kept open or closed with stitches, sutures, staples or healing strips. People with wounds from surgical procedures may develop serious complications, such as bleeding, bruising, blood clots, infection, tissue necrosis (death) or splitting open of a surgical wound (dehiscence).
A physician should be contacted if:
A foreign object is embedded in the wound.
A wound is slow to heal or does not appear to be healing.
Signs of infection are observed, such as redness, swelling, warmth, tenderness, increased pain or drainage of pus. Fever (100 degrees Fahrenheit [37.8 degrees Celsius] or over) is also a sign of infection.
The area around the wound feels numb.
If not treated properly, chronic wounds can lead to serious complications, including:
Infection. Some types of infection include cellulitis, sepsis (life-threatening blood infection), osteomyelitis (inflammation of the bone) and septic arthritis (bacterial infection of a joint).
Endocarditis. Inflammation of the lining of the heart.
Heterotopic bone formation. The occurrence of a bone growth in an abnormal location.
Maggot infestation.
Meningitis. Inflammation of the membrane covering the brain and spinal cord.
Amyloidosis. A rare disease that causes the accumulation of amyloid (a protein and starch) in tissues and organs that can result in impaired function of organs.
The healing process
After the skin is broken, healing begins. The healing process consists of phases, including:
Inflammatory phase. Begins immediately and usually lasts two to five days. It consists of bleeding, blood vessel narrowing, clot formation and release of chemical substances into the wound that begin the healing process. Debris is cleared from the wound by specialized cells.
Proliferative phase. Usually lasts from two days to three weeks. A matrix or latticework containing new cells and blood vessels (capillaries) forms. The new blood vessels (which give the wound its pink, red or purple color) will provide the rebuilding cells with oxygen and nutrients to sustain growth and support production of proteins (mainly collagen). Collagen is the primary substance in scars and acts as a framework upon which new tissue builds.
Remodeling phase. Usually lasts from three weeks to two years. The collagen becomes more organized, strengthening the tissue. The amount of blood vessels becomes less and the pink, red or purple color diminishes. The area gains strength over time, usually regaining 70 percent of its original strength.
Epithelialization. New skin (epithelial) cells are formed, which serve as a protective layer between the environment and the body.
There are many factors that can interfere with wound healing. The most common reason for impaired wound healing is infection. All wounds are contaminated with bacteria. Infection occurs when a patient’s immune system is unable to fight off the bacteria. Sometimes this happens because a patient’s immune system has been weakened by disease, such as diabetes. The long-term effects of diabetes impair wound healing by reducing blood flow and sensation to the injured area. In some cases, people with diabetes do not even realize they have wounds.
Older age, paralysis or other causes of limited mobility, and hospitalization also increase a person's risk for wound infection.
Other factors that impede wound healing include:
Drugs. Some types of medications, such as corticosteroids, can slow wound healing.
Nutritional problems. Deficiencies in the protein, zinc and vitamins A, C and E can impact wound healing.
Tissue necrosis (death). The death of tissue cells resulting from lack of blood supply or radiation injury may slow the healing process.
Hypoxia (reduction of oxygen supply to tissue). This may occur due to loss of blood, unrelieved pain or hypothermia (abnormally low body temperature), especially in the extremities of the body, such as the hands and feet.
Excessive tension on wound edges. This can restrict blood flow to a wounded area and impair healing.
Presence of another wound. When a patient has more than one wound, there may be “competition” among wounds, which may slow the healing process.
Low temperature. The temperature of tissue in the upper and lower extremities of the body can slow the healing process in these areas.
Treatment of wounds
Most common types of wounds do not require emergency medical care and can be treated with first aid measures.
Patients with cuts, scrapes, lacerations, scratches and abrasions should take the following measures to avoid infection and other possible complications. They include:
Control the bleeding. Minor skin injuries stop bleeding on their own, but wounds on the face, head or mouth may bleed longer. Bleeding can be stopped by using a finger or hand to apply pressure to the wound for 20 to 30 minutes. People should avoid lifting the cloth or bandage during this time to check if the bleeding has stopped. Doing so can damage the blood clot that is forming in the wound and cause the bleeding to begin again. When blood soaks through the cloth or bandage, additional cloth or bandages should be placed over the existing material and more pressure should be applied.
Clean the wound. Patients should wash their hands and then use cool water, soap and a washcloth to clean the wound. This helps prevent dirt, oils and bacteria from entering the wound. The area around the wound should also be cleaned with soap and a washcloth to avoid infection. Hydrogen peroxide, iodine or other sterilizing substances should not be used because they can irritate the injury and impair the tissue's ability to heal. When dirt or other particles (e.g., glass, splinters) remain in the wound, tweezers that have been sterilized with isopropyl alcohol (rubbing alcohol) can be used to remove the debris.
Apply a topical antibiotic. A thin layer of antibiotic ointment or cream should be applied to the wound once the area is cleaned.
Cover the wound. This protects the healing wound from friction, avoids contact with dirt and debris, keeps the ointment in place and helps keep the wound dry.
Change the bandages regularly. Bandages should be changed at least once a day and any time the dressing gets wet, contaminated or dirty. Each dressing should only be used once, and unused dressings should be stored in their original packaging, in a clean, dry place. Individuals should wash their hands before handling the unused bandages and be careful to ensure that the side of the bandage that will cover the wound is not touched or otherwise contaminated.
Minor burns should be treated by taking the following steps:
Cool the burnt skin. If possible, hold the burnt area under cold running water for 15 minutes. Otherwise, soak the burn in cold water or hold cold compresses over the area.
Apply lotion to the skin. Once the burnt area is cooled, an antibiotic ointment may be used.
Protect the burn. The burnt area should be covered with a sterile dressing or bandage.
Use an over-the-counter pain reliever. Aspirin, acetaminophen or other over-the-counter medications can reduce pain, inflammation and swelling.
In some cases wounds require professional medical assistance. Medical attention should be sought if:
A cut is longer than 1/3 inch (.77 centimeter), is located on the face, appears deep or has edges that separate
Bleeding does not stop after several minutes or when pressure is applied
Blood is spurting from the wound
Symptoms of nerve or tendon injury appear (e.g., numbness, loss of movement below the wound)
A scrape is deep
Dirt, glass, gravel, metal or other substances remain embedded despite rinsing
The wound is from a puncture
The wound is causing severe pain
The patient has not received a tetanus vaccine in the last five years
Foul odor emits from the wound
Patients should contact a physician if wounds do not seem to be healing or are slow to heal. Before treating a chronic wound, a physician usually conducts a physical examination, and collects a medical history and list of current medications, to determine why a wound is not healing properly. The physician will also visually inspect the wound.
A physician may also conduct tests to determine whether an underlying condition or disease may be impairing the healing process. They include:
Blood test. A test that determines the amount of any given substance in the blood and identifies abnormally high or low levels.
Tissue culture. A sample of tissue is removed from the wound and cultured to determine if known infection is impairing wound healing.
MRI. Safe and noninvasive imaging tests that can help physicians diagnose diseases of numerous organs and vessels. It uses powerful magnets to produce images on a computer screen and film.
Ultrasounds. An imaging technology that uses sound waves to produce images of the shape and outline of various tissues and organs in the body. The images produced are called a sonogram.
Biopsy. A sample of tissue is removed from the wound and studied under a microscope to determine abnormalities that may be impairing the healing process, such as whether the tissue is cancerous.
A physician may take a number of steps to treat a chronic wound, including:
Nutrition counseling. Patients’ diets must provide enough nutrition to promote proper wound healing. Getting adequate amounts of protein, zinc and vitamins A, C and E are especially important.
Antibiotic therapy. Infections that may be slowing the healing process can be treated with antibiotics (medications that kill or slow the growth of harmful microorganisms, such as bacteria).
Foreign body removal. Fragments of dressing or suture materials or other foreign bodies may remain in wounds and impair healing. Removal of these foreign bodies can often speed the healing process.
Wound irrigation. Wounds are sometimes washed with saline solutions to fight or prevent infection. Whirlpool treatments (hydrotherapy) are sometimes used for large and infected wounds. This can aid healing by keeping skin clean and removing dead or contaminated tissue.
Wound dressings. Dressings may be used to protect wounds after surgery. Wounds are kept moist with an ointment that is covered by a bandage, which helps to promote healing. However, the bandage must be changed frequently because it can trap bacteria inside the wound and cause infection.
Growth factors. Proteins that stimulate cell growth. The U.S. Food and Drug Administration approved the use of growth factors to treat diabetic foot ulcers. They are applied directly to the skin.
Hyperbaric (high-pressure) oxygen treatment. Oxygen is essential to healing tissues. Patients undergoing hyperbaric oxygen treatment are placed in a chamber where 100 percent oxygen is circulated. The oxygen is pressurized so that air pressure may be two to three times greater than normal. This allows the lungs and skin to absorb more concentrated oxygen in a shorter period of time.
Removal of damaged tissue (debridement). Wounds need to be free of damaged, dead or infected tissue to heal properly. This may be accomplished with surgery, mechanical debridement (removing tissue with a high-pressure irrigation device), autolytic debridement (allowing the body’s own enzymes to break down dead tissue) or enzymatic debridement (applying topical debriding enzymes).
In addition, some types of chronic wounds, such as diabetic foot ulcers, can be prevented by educating patients about protective measures. Pressure ulcers can be prevented by taking measures, such as repositioning bedridden patients.
Questions for your doctor about wound care
Preparing questions in advance can help patients to have more meaningful discussions with their physicians regarding their conditions. Patients may wish to ask their doctor the following wound care-related questions:
How should I treat cuts, scratches and other types of common wounds?
When should I seek professional medical attention for a wound?
I have a chronic wound. What are my treatment options?
Is it likely my preexisting medical condition will cause me to develop more wounds in the future?
How long will it take for my wound to heal? Will it leave a scar?
Do you have experience treating chronic wounds, or should I seek a wound specialist?
What tests will you use to determine why my wound is not healing?
I have diabetes. Are there ways that I can prevent diabetic foot ulcers?
I just had surgery. Are there any special measures I should take to care for my wound?
