Basic Wound Care and Management

Everybody gets a wound now and then. For the most part, simply washing the affected area with soap and water, maybe a bit of antibiotic ointment and an adhesive bandage and the small cut or scrape will heal on its own within a few days. But what about larger, possibly more chronic wounds? That’s what we’re talking about today.

First things first: I’m not a doctor, and as the old saying goes “and I don’t play one on tv…”, however, I am a Type 2 diabetic, and I have seen my fair share of wounds, especially my own, over the years. I want to share with you some of the ways my wounds have been treated and how you, too, with advice and management from your medical professional(s), can manage your wounds effectively.

I’ve already mentioned I’m a diabetic and I have been for over a decade. This has caused some extraneous health issues for me, including heart issues and foot issues. Recently, I developed infections in my left foot which required two separate surgeries. Fortunately in both cases, amputation of the affected part of my foot (in and around my left great toe) was avoided. However, I was left with rather large and open wounds and those require a special kind of care and treatment to heal.

Patient Responsibilities

One of the first things you have to understand in wound management is that you, the patient, have a CRITICAL role in all of this – if you don’t do your part (cleaning, changing dressings, keeping a careful watch on the wound and the surrounding area, following doctor’s orders, taking medications, etc.) this can ultimately fail for you.

This is especially true if, like me, you’re a diabetic. Blood sugars (glucose levels) can have a dramatic effect on your healing rate. Watch your diet closely; take your medications on time, every time; test your glucose levels regularly and track the results. Stay in contact with the medical professional that is handling your diabetes care (primary physician, endocrinologist, etc.)

If you have a serious wound, more than likely you are under the care of a specialist for this, and again, I’m not writing to take the place of any medical professional or for you to leave their care and do wound management completely on your own. Follow any and all instructions they give you!

Now, let’s get started…

Personal Protective Gear

Depending on who is handling your wound care, sometimes it may be the patient themselves, sometimes it might be a family members or VERY close friends, or it could even be a home health practitioner, universal protective precautions need to be understood and observed to protect the patient and the caregiver. This includes washing of hands prior to any dealing with the wound. If you are where hands can’t be washed, use of a hand sanitizer can do in a pinch, but nothing beats the tried and true soap and water! The next layer of protection needs to be a medical glove of some kind. If you or a caregiver has a latex allergy, there are non-latex gloves, mainly made of nitrile, that will work.

If a wound is bleeding or leaking more than a few drops, you might even want to consider putting a disposable protective barrier (also known as absorbent underpads) on the floor, furniture or bedding where the wound will be over while cleaning or redressing it. These pads are available in many sizes and are invaluable in containing any leaks that can occur. If you can, clean and change the wound in a room or area that has a solid floor that can be cleaned with a disinfectant afterwards (vinyl flooring, linoleum, etc.) It is sometimes impossible to know if anything has gotten into carpet, thus much harder to clean it if it does, so it is best to try to avoid carpeted areas, if at all possible.

While a disposable medical mask is not necessary for all situations, if someone has a cold or is sneezing, coughing, or whatever, a mask to cover the mouth and nose of anyone dealing with a wound so that oral/nasal discharge, is a good idea. Masks with clear eye shields, or even just clear protective eye wear, can also be useful if a wound has the potential to splash drainage on someone else.

In severe cases, a disposable protective procedure gown can be worn to protect the wearer from any bodily fluids from a wound. Again, this is going to be in extreme cases, but use your best judgement on a case-by-case basis.

The next precaution is clean up. Dispose of all medical waste according to local, state, and federal regulations (and yes, wound care is considered biohazardous waste, but usually isn’t heavily regulated in an at-home situation.) In general, you want to keep wound care waste, including all personal protective items, segregated from your normal trash. Place everything from old dressing, to cleaning supplies (soiled gauze, bandages, etc.), personal protective gear, and/or protective barriers in a plastic garbage can liner (trash bag) and securely tie it shut. Place this bag in a closed outside receptacle so that no humans or animals can easily get to it, especially children and pets.

And did we mention – wash your hands. Again! Yes, after you’ve done everything, wash your hands! Your mom was right… washing your hands is the best way to fight germs!!

Finally, it’s a good idea to keep all of your wound care supplies together. One thing I’ve done is to get a transparent plastic storage box with a lid. It keeps everything close at hand and keeps it as clean as possible, too!!

Location, Location, Location

Depending on where your wound is located will sometimes determine how much help, if any, you might need in dealing with your own wound care. Another consideration is a patient’s ability to easily reach the wound and effectively care for it, as well as can they deal with the sight, and sometimes odors, of soiled dressing/bandaging. If a wound is on the back of your body, it’s not going to be easy to deal with. But the back of the calf is easier than say your lower back.

Before you get into a situation where you can’t care for your wound, determine with your medical professional what assistance you may require. Knowing you need help ahead of time gives your wound a better chance to heal properly.

Watch For Infection

For an open and lightly exuding (leaking) wound [this means a wound that might be slightly oozing blood and/or clear fluids] you want to always watch for signs of infection. Discolored, foul-smelling discharge, excessive redness and swelling around the area, can all be signs of infection. GET PROFESSIONAL MEDICAL HELP IMMEDIATELY. Infections left untreated can get out of hand quickly and can lead to more serious medical issues, up to and including surgery, amputations, or worse: death (yeah, not good!)

The “Wet-to-Dry” Wound Care Method

If you have no signs of infection, the most common treatment method for larger and chronic wounds is known as “wet-to-dry” dressing. Simply put, a wet dressing is placed into the wound itself, covered by a dry dressing, then whatever method is used to secure it in place (wrap, adhesive bandage or tape, etc.)

So how does this method work? The idea is that as the wet portion of the dressing dries out, it slightly adheres to the inside of the wound. Whenever you or a caregiver changes the dressing, the “wet” part (now dried) pulls a layer of the wound with it, also known as debridement. This is, in effect, helping to clean the wound, removing “bad” tissue, and helping the healing process. Unlike the small wounds I mentioned at the beginning of this article, these large wounds won’t heal in a day or two. Sorry, you’re in this for the long haul! However, slowly, but surely, this helps your wounds fill in from the inside out, then close over.

Keep That Wound Clean

Another part of your wound care regimen is keeping the wound clean. If your medical professional clears you to do so, warm, soapy water in the wound during a shower is a great place to start. If you use a wash rag during your shower, consider using one for the rest of your personal cleaning, then one just for the wound. You don’t want to introduce contaminants from other body parts into a wound you’re trying to heal!! At the same time, you don’t want contaminants from a wound on any other body part, either. When you are drying off after the shower, pat the wound area dry with some clean gauze. It’s not recommended to use the same towel you’re drying the rest of your body, as again, you’re trying to keep contaminants out of the wound area.

Helpful tip: clean wash rags and towels separately from other household linens, using the Sanitary setting on your washer (if it has one) and using liquid bleach on these loads. In my case, during the times I’m treating an open wound, I have my own linens that no one else in my family uses.

But what about the times during the day or night that you’re changing the dressing and not showering? What then? Well, easy enough, you can cleanse the wound and surrounding area with a dedicated wound cleanser or just use a wound wash of commercially available sterile, saline solution. This can be sprayed directly in the wound or applied using standard 4” x 4” (other sizes are available!) cotton gauze (normally called a “4 by 4”) and gently rubbed to clean out any remaining debris from the dressing just removed, and to prepare the wound for the new dressing. You don’t need to be too aggressive in cleaning out the wound, but don’t be too soft, either. The object here is to remove any loose tissue, but not to make the wound worse. After cleaning, gently pat the wound dry with a clean 4×4.

Let’s Get The Wound Dressed!!

Now it’s time to dress the wound so it can get back to healing. In the wet-to-dry method, take a new piece of cotton gauze, using the size most appropriate for the size of your wound, dampen, but not dripping wet, with sterile saline solution and cover just the area of the open wound. You DO NOT want to have the wet area on good skin/tissue, as this could cause that area to start breaking down over time and that’s not the goal.

An example of this is a wound I had on my foot after one of the surgeries previously mentioned. The wound was 1 cm deep, so I used 4×4 cotton gauze, dampened with sterile saline solution, then lightly packed into the wound, making sure it was ONLY in the wound. I sometimes had to use more than one piece of gauze, as the wetting of the material will make it shrink somewhat.

After the wet portion is in place, cover with two or three new pieces of gauze to completely cover the wet area and the immediate area of tissue surrounding the wound. Once the clean gauze is in place, wrap with rolled gauze, or use medical tape or large adhesive bandages to hold the dressing in place. Depending on where your wound is located and your sensitivity to the adhesives on medical tape or adhesive bandages, be cautious of the repeated placing and removing of adhesives. This can cause skin break down, too.

Other Wound Care

OK, we’ve covered cleaning and dressing. But wait… there’s more! You have to manage your wound the rest of the time, too! If, like me, your wound is on a foot, you may have to limit your walking, or even have to use a special walking boot to help off-load pressure on the area. Think of where your wound is located – what movements do you make in your daily life? You don’t want the wound to be tugged or pulled, nor do you want excessive pressure placed on the wound area. All of this contributes to whether or not your wound heals.

You also need to keep the wound area as clean as possible out in the real world. We’re not suggesting staying inside a bubble while you heal, but you do need to try and keep contaminants away from that wonderful dressing you just put in place! That may mean no working in the garden or cutting the lawn for a while, as the dirt and dust getting into the wound won’t do you any good. Just think things through, maybe take it a little easier while you’re on the mend.

Conclusions

Wound care isn’t an exact science. Every wound and every patient is different. Some wounds require more care than others, some heal faster than others. But this is a certainty: all wounds, no matter how large or small, need to be taken seriously. Your health could be at risk if they aren’t.

If you have any questions, please contact the medical professional who is treating your wound issue. If it is a true emergency, call 9-1-1 immediately. Don’t wait for a wound to get out of hand before taking care of it.

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