Wound care health education

Moisturizing promotes healing, prevents infection, and reduces wound tension. Most of the old experiences we have believed in since childhood: "Wounds should be allowed to air out, applying red lotion will heal faster, and eating soy sauce will leave scars" are mostly not in line with current clinical nursing standards.

Last week, I met a young man in the emergency department who broke his knee while riding a shared bicycle. He applied red lotion at home and let it dry for three days. The wound was oozing with pus and smelly before he came in. He even plausibly said that my mother said that the wound would heal faster if it had to be ventilated. In fact, regarding the issue of "airing or wrapping", there have indeed been two iterations of concepts in clinical practice: the dry therapy mentioned by the older generation is that in the early years, there was no suitable sealing dressing, and it was easy to accumulate exudate and induce infection. Now evidence-based medicine has confirmed it. In 1962, Winter's experiment made it clear that the crawling speed of epidermal cells in a wet environment is twice that of a dry environment, and the healing speed can be nearly half faster. Of course, this does not mean that all wounds must be tightly stuffed. If there is a lot of exudation in burns or infected wounds, you still need to use exudate-absorbing dressings to change frequently. It is not enough to cover the exudate and soak the surrounding normal skin. It must be flexibly adjusted according to the wound condition.

Many people ask me how to deal with it? The most stupid thing I encountered in the outpatient clinic was when the patient came over with a red wound and said that he had wiped it three or four times with iodine at home, and the pain was so painful that he couldn't sleep all night. There's really no need to go to such trouble. The first step in treatment is to rinse with either normal saline or cold water. Just wash away the sand and dust on the wound. It is okay to disinfect the surrounding healthy skin with iodophor. Do not rub hard on the fresh wound. The irritating disinfectants will kill the proliferating new granulation cells and slow down the healing speed.

Regarding whether to apply antibiotic ointment to small wounds, there are currently two schools of clinical opinion. One school believes that small wounds that are ordinary and clean can resist infection by their own immunity. Indiscriminate use of antibiotics can easily lead to drug resistance, so there is no need to apply it at all.； The other group believes that if the wound is scratched in a dirty environment such as an outdoor construction site or a vegetable market, applying a thin layer of mupirocin and erythromycin ointment can significantly reduce the risk of infection. Both statements are correct. You can choose according to your own situation. If you hit a clean corner of the table at home, just rinse it and wrap it up. If your hands are full of mud, there is no harm in applying it for two or three days.

Oh, by the way, don’t put band-aids on them randomly. For small scratches with little exudation, just put on an ordinary band-aid or hydrocolloid dressing and change it once a day. When changing, if it gets stuck, moisten it with normal saline and then remove it. Don't tear it off and tear the newly grown skin. For burns and abrasions with a lot of exudation, use a thicker foam dressing, which has a strong ability to absorb exudate. It only needs to be changed every two or three days. Last time, a little girl had a small cut on her finger. She had to wrap the Band-Aid three times for fear that it would fall off. When it came, the tip of her finger was purple and she almost died from ischemia and necrosis. Please don't do this kind of thing.

The scarring issue that everyone is most concerned about, I have explained it eight hundred times, and it has nothing to do with eating soy sauce. Last week, a mother brought her child who broke his face for a follow-up consultation. She said that she had been drinking white porridge for three days and was afraid of scars caused by eating soy sauce. I advised her to quickly add two eggs to the child. The pigment in soy sauce is metabolized by the gastrointestinal tract and will not deposit in the wound at all. As long as you are not allergic to it, you can eat beef, seafood, mango, etc. High protein can help the wound grow faster. The two main culprits that are really prone to scars are infection and repeated pulling of the wound - for example, if the wound on your knee has just scabbed and you run a marathon, the newly grown tissue will be pulled apart by the tension, which will definitely leave a wide scar. For the wound near the joint, try to avoid major movements in the first half month after it has just grown. If you are afraid of leaving scars, put a tape on both sides to pull the skin. It is much more effective than buying a scar removal cream that costs hundreds of dollars.

Nowadays, many people say that scar removal cream is an IQ tax, and some people say that it is very easy to use. Objectively speaking, regular silicone scar removal products can indeed soften and smooth the red hypertrophic scars that have grown, but the premise is that you have to wait until the wound is completely healed and the scabs have fallen off before applying it, and it must be applied every day for more than 3 months to be effective. If you apply it just after a cut, or apply it for three to five days to eliminate the scar, it will definitely be a waste of money.

In fact, wound care is really not that mysterious. Don’t believe those folk remedies that apply toothpaste, apply fresh aloe vera, and sprinkle incense ash. Toothpaste is cool, but it blocks the exudate and makes it easy to get infected. There are many people who have allergic reactions to fresh aloe vera and their faces are sore. If the wound is so deep that you can see the yellow fat, or the bleeding won't stop for ten minutes, or it was pricked by a rusty iron nail or something dirty, don't mess around at home, go to the hospital quickly. Stitches are needed, tetanus is needed, and tetanus is more effective than any other home remedy.