Wound Care

A wound is a disruption of tissue structure caused by a violent force. These are tissue damages to the skin, subcutaneous tissue, muscles, organs, or bones that can occur as a result of injury, trauma, surgical procedure, or illness and can occur on any part of the body.

There are different types of wounds, and each type has its own characteristics and requires an appropriate approach to treatment and care. Proper wound treatment is important to achieve a fast-healing process and prevent infections or complications. Wound treatment includes cleaning, disinfection, covering, and sometimes stitching or other forms of medical intervention, depending on the type and severity of the wound.

If you have a deep, larger  wound that is uncontrollably bleeding, infected, or causing significant discomfort, it is always advisable to seek medical help to receive proper care and treatment.

Types of Wounds

Open and closed wounds are the two main categories of wounds that differ in their appearance and characteristics.  Open wounds are wounds where the skin is broken or damaged, creating a visible crack or opening on the surface of the skin. Closed wounds are wounds that do not have a visible crack or opening on the surface of the skin. Instead, the internal tissue is damaged or injured.

Types of open wounds:

Incisions (Cuts) 

These are wounds that occur when the skin or tissue is damaged by a sharp or blunt object. Cuts are usually superficial, with the surrounding tissue structure remaining intact, and they can be quite painful. The contamination of the wound is minimal.

Lacerations (Tearing wounds)

These are caused by blunt objects with greater force. Lacerations are deep and irregularly shaped wounds that can result in tissue tearing. They are accompanied by extensive contamination and the presence of foreign bodies. These wounds typically require thorough cleaning and stitching to achieve proper healing. They most commonly occur in traffic accidents, industrial settings, and accidents involving agricultural machinery.

Puncture wounds

They can be caused by the penetration of sharp objects such as needles, nails, or pins. These wounds can be deep and potentially dangerous because the object can penetrate into the body’s interior. These wounds can be a source of serious infections.

Bites

Bites can result from animal or human bites. These wounds can be superficial or deeper, and they may carry a risk of infection.

Abrasion

Also known as scratches or superficial wounds, they are usually the result of friction between the skin and hard or rough material. These wounds are usually shallow and superficial. 

Avulsion

This is a serious type of wound characterized by the partial or complete tearing of tissues or organs from their normal anatomical position. This injury can occur as a result of trauma, in which the tissue or organ is separated from the body. Cutaneous avulsion refers to tearing of the skin from the underlying subcutaneous tissue. It can be superficial, where the skin is partially detached from the underlying surface, or complete, where the skin is completely separated. This type of injury can be severe and may lead to complications if not treated immediately.

Burns

Burns are a type of wound that occur when the skin or other tissues come into contact with a heat source, chemicals, electric current, or radiation. Burns are classified based on the depth and severity of tissue damage as first-degree, second-degree, third-degree, and fourth-degree burns.

Wounds can be acute or chronic.  Acute wounds are recent injuries that usually occur suddenly, such as cuts caused by a knife or scratches that are obtained during a fall. Chronic wounds are wounds that do not heal in the expected period, often due to underlying conditions such as diabetes, venous insufficiency or pressure ulcers. 

Wound assessment process

Assessing a wound is an important step in providing proper care and treatment. This process involves a detailed observation and evaluation of the various wound characteristics. 

Visual assessment

The first stage of the assessment is careful observation of the wound. Attention should be paid to the size, shape, depth, and location of the wound. Any presence of foreign bodies should also be noted, as well as signs of infection such as redness, swelling, discharge or unpleasant odor. 

Tissue assessment

Then the condition of the tissue surrounding the wound is assessed. Attention should be given to the color, texture, and integrity of the tissues. The presence of necrosis (tissue death) or granulation (the formation of a new healthy tissue mass) should be noted. 

Depth estimation

It is important to assess the depth of the wound to determine the degree of tissue damage. This can be especially important for deep wounds that may require specialized treatment or surgical intervention. 

Edge assessment

This is an important part of the evaluation and treatment of the wound, because the condition of the edges of the wound can affect the healing process and the selection of appropriate therapy. 

Exudate assessment

Exudate refers to the fluid that can leak from a wound. It is important to assess the amount, color, and consistency of the exudate, as it can indicate the presence of infection or inflammation. 

Infection assessment

Recognizing the presence of infection in the wound is important. This may involve testing samples of wound discharge and assessing signs of infection such as redness, warmth, swelling, discharge, and increased pain.

The role of pain in wound assessment  

Pain plays an important role in wound assessment as it is a subjective symptom experienced by the patient. Assessing pain helps healthcare professionals understand the intensity and nature of the patient’s pain, which can indicate the severity of the injury, inflammation, or wound infection. The intensity of pain should be assessed on a scale from 0 to 10, where 0 represents no pain and 10 represents the highest possible intensity of pain. This makes it possible to monitor changes in pain intensity over time and evaluate the effectiveness of pain therapy.

Consideration should be given to the characteristics of pain, such as sharp, dull, throbbing, stinging, or itching. This can provide additional information about the possible cause of pain and the response to specific therapies. Pain assessment should be included in the broader context of wound assessment. Attention should be paid to related symptoms such as swelling, redness, warmth, discharge, or the presence of infection. These symptoms can provide additional information about the severity of the injury or infection.

Pain relief can be achieved by different approaches, depending on the patient’s assessment and needs: 

Pharmacological approach: Involves the use of analgesics (painkillers) such as paracetamol, nonsteroidal anti-inflammatory drugs (NSAIDs) or opioids to control pain. These medicines may be administered orally, intravenously or locally depending on the severity and need for painful control. 

Local anesthesia: The application of local anesthesia can be used to temporarily numb the area around the wound to reduce pain during cleansing, bandaging or suturing the wound. This may include the use of local anesthetics or anesthetic gels. 

Alternative methods for reducing pain: These include the application of cold or warm compresses, as well as the application of ointments, gels, and creams.

Factors affecting wound healing

Factors influencing wound healing can be external (local) and internal (systemic) 

External or local factors play an important role in the wound healing process: 

• Wound cleanliness is crucial for preventing infections and encouraging healing. The wound should be carefully cleansed to remove bacteria, impurities, and dead tissue. The use of sterile instruments and compresses is also important in reducing the risk of infection.
• A humid environment stimulates wound healing because it allows granulation tissue and epithelialization. Maintaining an adequate level of wound moisture can be achieved by applying special healing dressings or compresses that maintain optimum humidity.
• In some cases, applying pressure to a wound can be useful to stimulate healing. For example, negative pressure wound therapy (vacuum wound closure) can improve circulation, reduce swelling, and stimulate the formation of granulation tissue.
• Good nutrition and hydration play an important role in the overall health of the body, which can affect the body’s ability to heal wounds effectively. Ensuring adequate intake of nutrients, vitamins, minerals, and fluids can promote wound healing.
• Tobacco smoking and alcohol consumption can adversely affect wound healing. Moderate physical activity can improve circulation and overall health, which can have a positive impact on wound healing.
• Infection of the wound can significantly slow down the healing process. Bacteria or other pathogens can cause inflammation, damage tissue, and make normal regeneration difficult. Therefore, it is important to adequately clean and disinfect the wound to reduce the risk of infection.

All of these external factors should be considered, and appropriate measures should be implemented to create a favorable environment for wound healing.

Internal or systemic factors also play an important role in the healing process of wounds: 

• The general state of health of the patient has a significant impact on wound healing. People who are healthy and in good condition may have a better chance of healing wounds faster. On the other hand, the presence of chronic diseases such as diabetes, cardiovascular disease or immune disorders can make it difficult to heal wounds.
• Good blood circulation is crucial for delivering oxygen, nutrients, and immune cells to the wound. Reduced blood supply to the wound area can slow healing. Circulatory disorders such as peripheral vascular diseases or damage to blood vessels can adversely affect wound healing.
• A strong immune response is key to suppressing infections and promoting wound healing. People with weakened immune systems, such as those who take immunosuppressive drugs or have autoimmune diseases, may have difficulty healing wounds.
• Good nutrition and adequate intake of nutrients are essential for effective wound healing. Lack of nutrients, such as protein, vitamins (such as vitamin C and vitamin A) and minerals (such as zinc), can slow wound healing.
• The healing process of wounds can be slower in the elderly due to the natural decrease in the regenerative abilities of the body. Older people often have poor circulation, slower metabolism, and reduced collagen production, which can affect wound healing.

It is important that systemic factors are optimal in order to ensure the best conditions for wound healing. In some cases, it may be necessary to consult a medical professional to manage systemic factors and identify possible problems that may affect wound healing.  

Different methods of wound healing

There are different methods of wound healing that are used depending on the type of wound, severity of wounds and other characteristics: 

1. Primary healing: This method is used for smaller wounds with straight assembled edges. The wound is closed with stitches, staples or medical glue to allow the edges of the wound to merge and allow rapid healing.
2. Secondary healing: This method is used for larger, deeper, or contaminated wounds. The wound is not closed with stitches but is allowed to heal from the inside out. The wound is regularly cleaned, compresses are applied, and the wound is allowed to heal gradually, forming granulation tissue and epithelialization.
3. Tertiary, or delayed primary wound healing, also known as secondary-intentional healing, is a method of healing that is applied to wounds that are contaminated or contain necrotic tissue but are not deep enough or complex enough to require full secondary healing. This method combines elements of primary and secondary healing.
4. Negative pressure wound therapy, also known as vacuum wound closure, is a method used to promote wound healing. This therapy involves the use of a special equipment (vacuum apparatus) that creates controlled negative pressure in and around the wound. The benefits of negative pressure wound therapy include improving blood circulation in the wound area, reducing edema, and accelerating the formation of granulation tissue. It is important to note that negative pressure wound therapy should be under the supervision of medical personnel.

General overview of wound management procedures:

Wound treatment is an important part of the process of treatment and prevention of infections. The basic procedures are: 

1. Before you start processing the wound, always wash your hands thoroughly with soap and warm water to reduce the risk of infection. You can also use alcohol-based disinfectant if you are unable to wash your hands.
2. If the wound bleeds, press it with clean gauze or cloth to stop the bleeding. If necessary, raise the wound above the height of the heart to reduce blood flow to it.
3. Rinse the wound with lukewarm or boiled water to remove dirt, foreign bodies, and microorganisms. You can use sterile saline or tap water that has been pre-boiled and cooled.
4. Clean the wound with mild soap and water, using sterile gauze, blunt side of a blunt instrument or a clean glove. Avoid using sharp objects like tweezers as you can make it worse.  
5. If you notice the presence of foreign bodies such as gravel or pieces of glass in the wound, do not try to pull them out yourself. Instead, seek medical help. 
6. After rinsing and cleaning the wound, you can apply an antiseptic to disinfect the area. An antiseptic such as chlorhexidine or iodine can be used as directed on packing. Do not overdo it with the use of antiseptics as this can slow down the healing process.
7. After processing the wound, cover it with a sterile bandage or gauze to protect against dirt and bacteria. Change the bandage at least once a day or according to the doctor’s instructions.

It is important to note that severe wounds or those that show signs of infection should be examined and treated by a medical professional. If you have questions or doubts about the treatment of the wound, be sure to consult your doctor. 

Cleaning the wound

Cleaning the wound is extremely important in the process of treatment and prevention of infections. Here are some reasons why cleaning wounds is important: 

Wounds are often exposed to different types of dirt such as dirt, dust, bacteria, or residues of materials that caused the injury. Cleaning the wound helps to remove this dirt, reducing the risk of infection. 

Wounds may contain foreign bodies such as pieces of glass, metal, or wood, which can make healing wounds difficult. Cleaning the wound allows the removal of these foreign bodies and creates more favorable conditions for wound healing.

Cleaning the wound can stimulate circulation in the wound area. Improved circulation brings more oxygen and nutrients to the wound, which helps in the healing process. In addition, cleaning the wound stimulates granulation, which is a healing phase in which new cells and tissue are created to fill the wound. 

It is important to note that wound cleaning should be done carefully and follow the instructions of healthcare professionals.

Solutions for cleaning wounds

• Saline, also known as isotonic sodium chloride solution, is often used to clean wounds. This solution has a similar composition to body fluids, which makes it mild and non-irritating to tissue. Saline helps to remove dirt and debris from the wound.
• Antiseptic solutions are designed to destroy or inhibit the growth of microorganisms in the wound and reduce the risk of infection. Some of the commonly used antiseptics in wound cleansing solutions are chlorhexidine, povidone iodine, and actinidin.
• Solutions with mild soap can be used to clean seal wounds. Soap helps to remove dirt and grease from the wound. It is important to use mild soap that will not irritate or damage tissue.
• Hybrid solutions combine several ingredients to improve the effectiveness of wound cleansing. For example, a combination of antiseptics, surfactants and hydrogels can be used to cleanse and hydrate the wound.

It is important to consult a medical professional or pharmacist to choose the appropriate solution for cleaning the wound and follow the instructions of the specialist on how to apply the solution and how often the wound should be cleaned.  

Wound cleaning technique

There are several techniques that can be applied when cleaning the wound. These are some of the most common techniques: 

Wound washing: The wound can be washed off with lukewarm physiological or other solution recommended by a medical professional. Using a syringe or mild water pressure, dirt and debris from the wound can be washed away. It is important to use a light jet of water so you will not cause additional tissue damage. 

Extraction: If there are foreign objects in the wound such as pieces of glass, metal, or wood, they should be carefully removed. For this, sterile tweezers or another instrument recommended by a medical professional can be used. It is important to carefully pull-out foreign objects so you don’t cause additional injury. 

Removal of necrotic tissue: If the wound contains necrotic (dead) tissue, it may be necessary to remove it to allow healthy healing. This is usually done with the help of a medical professional who uses appropriate instruments and techniques like debridement. 

Use of antiseptics: After cleaning the wound, an antiseptic may be applied to reduce the risk of infection. The antiseptic is applied to a sterile gauze or tampon, and then carefully passed over the wound surface. It is important to follow the instructions of a medical specialist on the type and method of application of antiseptics. 

It is important that wound cleaning techniques are applied carefully and sterilely to avoid further tissue damage or infections.  

• Principles of aseptic technique

Aseptic technique refers to a set of procedures and principles that are applied to prevent the introduction of microorganisms into a sterile environment and minimize the risk of infection. These are the basic principles of aseptic technique: 

1. Clean surface: The working surface, instruments and materials used in aseptic technique should be clean and without visible dirt. Regular cleaning and disinfection is recommended.
2. Proper hand washing: Detailed hand washing before starting aseptic technique is key. Use liquid soap and warm water, and properly rub all surfaces of your hands for at least 20 seconds. After washing your hands, use sterile gloves for extra protection.
3. Use of sterile materials: All materials that will come into contact with the wound, such as sterile gauze, syringes, instruments, and bandages, should be sterile. Open sterile packages or use sterile disposable materials to ensure that no contamination is introduced.
4. Avoid contamination: Avoid touching non-sterile surfaces, as well as unnecessary contact with skin, hair or other objects that could lead to contamination.
5. Proper handling of instruments: If you use instruments during aseptic technique, handle them carefully. It is recommended to sterilize the instruments before use and carefully hold sterile instruments to prevent contamination.
6. Maintaining the sterile zone: Define the sterile zone around the wound and carefully manipulate the materials within that zone. Maintaining the sterile zone helps prevent contamination of the wound during the procedure.

 

• Debridement

  Debridement is a procedure to remove necrotic (dead) tissue, foreign materials and debris from a wound to create favorable healing conditions. This technique is applied when the wound contains unhealthy or necrotic tissue that can interfere with the healing process or increase the risk of infection. 

  • Soft debridement: This technique involves the use of sterile gloves and tweezers to carefully remove necrotic tissue from the wound. Sometimes soft gauze or sterile bandages are also used to attract and remove necrotic tissue.
  • Autolytic debridement: This method uses wet occlusive bandages or special hydrogels to create favorable conditions for the natural breakdown of necrotic tissue by enzymes in the wound. This process may take a long time.
  • Enzymatic debridement: In this procedure, enzymes (e.g., collagenase, trypsin) are used to specifically break down necrotic tissue. Enzymes are applied to the wound and left to act for a certain period of time before rinsing or removing.
  • Surgical debridement: This technique involves surgical removal of necrotic tissue from the wound. It can be performed with a scalpel, scissors, electric instruments, or a laser. Surgical debridement is often used in cases of severe or deep necrosis tissue.

  The choice of the appropriate debridement method will depend on the characteristics of the wound, the type of necrosis and the general condition of the patient. 

Types of wound dressings 

There are several types of dressings that can be applied in the treatment of wounds. Choosing the right type of bandaging will depend on the type of wound, the stage of healing, the presence of infection and other factors. Several common types of bandaging: 

Dry bandaging is used when the wound is dry and without signs of infection. In this case, a sterile gauze or bandage is placed over the wound to protect against external factors and maintain the moisture of the wound. 

Wet bandaging is used when the wound is wet or when it is necessary to maintain a moist environment for faster healing. This is achieved by using special hydrogel bandages or other materials that retain moisture in the wound. 

Foamy bandaging is used for exudative wounds, i.e., wounds that produce large amounts of fluid. A special sparkling gauze or sparkling bandage is used that absorbs excess fluid and maintains a moist environment. 

Hydrocolloidal bandages are flexible bandages that create a humid environment around the wound. They are often used for superficial wounds or minor burns, as they help relieve pain and promote healing. 

Compression bandages are used in wounds that tend to bleed or in edema. These bandages put pressure on the wound and surrounding tissue to reduce bleeding and control swelling. 

Antimicrobial bandages contain agents that prevent the growth of microorganisms and can be used in wounds with a high risk of infection. These bandages may contain silver, iodine, or other antimicrobial agents. 

It is important that the selection of the type of dressing is carried out in accordance with the advice of a medical specialist and to adhere to the recommended procedures for bandaging the wound. 

Primary dressing

Primary bandaging is a wound dressing technique applied immediately after the wound is closed to provide protection, support the healing process, and prevent infections. This technique is applied when the edges of the wound are clean, well aligned, and able to connect directly. 

First, the wound is carefully cleaned and disinfected to eliminate potential sources of infection. Then, the wound is carefully closed and connected. This can be achieved using various techniques, such as seams, self-creating threads, skin patches or adhesive strips. Next, it is carefully placed over the wound with sterile gauze or sterile bandage to provide additional protection and prevent contamination of the wound. Additional fixations, such as bandages or patches, can be used to ensure that the bandaging remains in place. 

The benefits of primary dressing include a faster healing process, a reduced risk of infection, fewer scars, and greater comfort for the patient. The decision on the application of primary bandaging is made by a medical professional based on the assessment of the wound condition. 

Secondary dressing

Secondary bandaginiss a wound dressing technique applied when the conditions for primary bandaging are unfavorable or impossible. This technique is used when the wound contains necrotic tissue, has abundant secretion (exudate) or is already open and requires further healing treatments. 

After cleaning the wound, it is necessary to apply appropriate treatment to promote healing. This may include the use of special solutions, gels, hydrocolloidal bandages, alginate, or other wound materials. After treatment, a primary layer is placed on the wound, which can be sterile gauze or special compresses that help absorb excretion from the wound. A secondary layer is placed over the primary layer, which can be sterile gauze, bandage or other materials that provide additional protection and support to the wounded area. Then additional fixation can be used, such as bandages or patches. 

It is important that secondary bandaging is carried out under the supervision of a medical professional in order to properly assess the wound and select the appropriate materials and techniques of dressing for each patient. 

 

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