What is wound care?

What is wound care?

Wound care is the practice of treating skin injuries to promote healing. Wound care typically involves cleansing and dressing wounds and preventing and treating infections. Wound care manages underlying conditions that may delay healing, such as diabetes and poor circulation. Good wound care will require a team approach between various medical providers, specialists, with patient compliance and caregiver assistance.

Those who care for a minor wound at home may need simple solutions such as cleaning a cut and keeping it covered daily until it heals. Other wounds may require medical attention for more extensive treatment protocols that require specialized advanced dressings and incorporating medications for pain management and infection control. The goal of most wound care is to heal the wound as quickly as possible. However, not all wounds have the potential to heal. For people toward the end of life, skin failure and breakdown may be unavoidable. The goal, in this instance, will be to limit deterioration, manage odor and drainage.

When wound care is performed in a medical setting, a doctor or specialist initiates an assessment to determine the level of injury. Specialized testing for proper diagnosis and development of an appropriate care plan may be performed. Daily care of the wound may be performed by nurses or therapists. Severe wound issues may require inpatient hospitalization for surgical intervention for the removal of dead necrotic tissue, infection management, or to help revascularize blood flow to the area to promote healing.

When medically stable for discharge from the hospital, people may continue to require medical care. Depending on the wound location on the body and the intricate needs of the dressing protocol, some patients will be able to manage with guided self-care. Others may be reliant on family or friend caregiver support. More complicated treatments may require home care services for those people who are homebound. Others will need frequent treatments in an outpatient wound care clinic. Managing a wound care case will have many factors beyond just the wound presentation; comorbidities, living situations, mobility concerns and insurance limitations will be significant drivers of the care plan.

How wounds start are divided into four main categories of wounds.

  1. Abrasions are scrapes that are superficial disruptions to the top layers of the skin that occur when your skin rubs or scrapes against a rough or hard surface like road rash.
  2. Lacerations are deeper cuts or tears typically resulting from an accident with knives or tools with significant bleeding.
  3. Punctures are holes that can be severe depending on the location and depth of injury, typically caused by a nail, needle or bullet.
  4. Avulsions are a tear of the skin from the tissue beneath which are typically violent accidents that bleed heavily and require medical attention.

When wounds are healing, all four phases of healing will occur in an organized and progressive manner.

  1. Homeostasis is initiated immediately with a clot formation to stop the bleeding.
  2. Inflammation activates the body’s immune response to start the healing process.
  3. Proliferations occur as the new epithelial tissue fills in the wound depth and cells grow to approximate the wound edges.
  4. Maturation phase of healing occurs as the scar tissue continues to mature over the next months to years after wounding.

Infection is a potential issue through any phase of healing. Cardinal signs of infection will include increased redness, pain, swelling and odor. Oral antibiotics are a common treatment of infection but intravenous antibiotics may be required for chronic and severe infections. Patients with poor circulation may require a multimodal approach for a distal nonhealing wound especially if diabetes is a contributing comorbidity. Specialty antimicrobial wound cleansers and advanced wound care dressing may be used to treat infection topically.

In early wound care history, gauze was the primary wound care product with the goal of keeping the area protected. Between 1970-90s, moist wound healing became a standard of care when studies showed faster healing, less pain with dressing changes and improved scar appearance. These results revolutionized the wound care industry with dressing innovations and categories that donated moisture or absorbed excess drainage. Different products may be needed at different times especially depending on drainage, infection and depth. More recently dressings have become more biologically active and can be appropriately used during a variety of stages and wound presentations.

When wound healing is complicated wounds, additional modalities can be used to improve healing. Offloading or pressure relief is often required when mobility is an issue and bony prominences are at risk for further breakdown. This may include turning and positioning, pressure-relieving mattresses or cushions and increasing mobility with physical therapy. Electric stimulation has been found to increase blood flow and encourage new cell growth. Light therapy has been used to improve angiogenesis. Compression is often used with venous insufficiency and chronic edema. Hyperbaric oxygen therapy is an option for ischemic and necrotic areas, which can be beneficial to people with diabetes. Negative pressure wound therapy is another tool that may be used for dehisced, deep and large surface area wounds.

What wound treatment is appropriate for a wound will likely change throughout the course of the healing journey. Treatment will continue until the wound is fully closed and there is no longer drainage. Extra protection with barrier creams and scar products may be needed while the new tissue is still maturing. New tissue is fragile for a significant period of time and is not as strong as the surrounding non-injured skin. New breakdown in the same location is possible if friction, shear and pressure are not minimized.

Scar tissue formation is a consideration of care after the wound has healed. Many patients have concerns over cosmetic appearance for a natural-looking scar. Scars can take over a year to transition from a purple/red state to their pale final version. The use of SPF during this time is often recommended to prevent discoloration from lasting. Scar massages can help with the desensitization of hyperactive scars and improve skin mobility to prevent adhesions. Cosmetic treatments like lasers, microneedling and the use of topical agents like silicone and scar fade creams on a daily basis can help to improve appearance under the supervision of dermatologists, plastic surgeons and/or aestheticians to develop a personalized plan.

©2020 Human Biosciences, Inc. The content presented here is for your information only. It is not a substitute for professional medical advice.