Wound care definition

Covering the entire cycle of wounds from occurrence to complete healing, through multi-dimensional interventions such as local wound treatment, systemic risk intervention, and patient health guidance, it accelerates tissue repair while reducing complications such as infection and scar hyperplasia, while minimizing patients' pain, anxiety and other discomforts. It includes both clinical professional operations and detailed requirements for daily care at home.

Last week at the community health service center’s free science clinic, I met an aunt who had a shallow ulcer on her knee. She changed the Band-Aid and applied iodophor every day at home. It took half a month to heal. When I lifted the Band-Aid, it was covered with eczema, and there were white spots all over it. She was particularly confused about the stains: "I sterilize every day, even when I take a shower, I wrap myself in plastic wrap and don't dare to touch the water. Why can't it get better?" In fact, this is also the misunderstanding of most people about wound care. They think it is nothing more than a three-piece package of "disinfect, wrap, and don't touch the water." It's really not the case.

Speaking of it, the academic community has actually had disagreements on the core direction of wound care for a long time. In the early years, when we were in school, the textbooks taught the concept of dry healing. The core was to keep the wound dry and promote scabbing. It was believed that scabbing was equal to healing. At that time, everyone advocated leaving a bruise to dry and not covering it. Now many elders still have this concept. Later, after the theory of wet healing came out in the 1960s, many clinicians began to promote moist environment repair, saying that epithelial cells can crawl twice as fast in an environment of constant temperature and humidity, and are less likely to leave scars. The two views have been arguing for many years. When I attended academic conferences two years ago, there were old experts and young doctors arguing over adaptation plans for different scenarios. Now we are slowly reaching a consensus: there is no absolute right or wrong, it all depends on the actual situation of the wound.

When I was rotating in the emergency surgery department two years ago, I would encounter more than a dozen patients who cut vegetables and cut their hands in one night. Nine times out of ten, they would ask the same question: "Doctor, should I leave my wound open or wrapped?" In fact, the answer is never fixed - if it is just a scratch, If the epidermis is slightly broken, there will be very little bleeding. If the home is well ventilated and dirt will not come into contact, it can be left to dry without even applying a band-aid. However, if the wound is a bit deep and it is inevitable to touch dirt when working, then it must be wrapped with a sterile dressing to avoid secondary contamination. If you encounter patients with diabetes or varicose veins in the lower limbs, even if it is just a small broken blister, you must put the requirements of controlling sugar and improving local circulation first. Otherwise, even if you change the dressing every day and use the best dressing, it will not be cured.

There is also a very hotly debated issue, which is whether the wound can be exposed to water? The old belief is that contact with water will lead to infection. Many people have small wounds on their hands and wear three layers of gloves to wash dishes. The palms of their hands are covered with sweat and the wounds become red and itchy. The current clinical consensus is that as long as the wound is clean and has no obvious exudation, it can be touched with warm water normally. After washing, just use a clean cotton towel to gently dry it. Instead, you cover the wound and dare not wash it. The accumulation of grease, sweat, and dust on the surrounding skin is a breeding ground for bacteria. Of course, it is best to avoid contact with raw water in the first 3 days after stitches, or in wounds that are obviously ulcerated and pus-filled. This is nothing to be discouraged. It just depends on the specific situation.

Having been doing wound care for almost 8 years, I feel that the definition of "wound care" has never been a rigid clause written in the guide. Last time I changed the pressure ulcer dressing on the sacrococcygeal area of ​​an old woman who was bedridden for a long time. When I left, I stuffed her family with an extra slow-rebound cushion and told her to turn over every two hours and not press the wound. Later, the family sent me a message saying that the wound had healed twice as fast as before. Do you think this act of stuffing the cushion and telling her to turn over was considered wound care? Of course it counts. In essence, it is never just about looking at the piece of broken skin. You have to look at the living person to really get the care right.