The Reality:
- Peroxide washes off those cells and dries out the area too much
- Scrubbing is very painful!!
- Scrubbing tears/washes off fragile new skin cells before they can grow properly
- Peroxide and iodine kill the fragile new skin cells along with the intended bacteria
- Potent new antibiotics significantly reduce chances of threatening infections.
What are the major goals of advanced wound care?
- Cleanse Gently
- Remove Debris
- Absorb Drainage
- Protect Tissue
- Control Edema
Wound Care Basics
Goals of Appropriate Wound Care
- Cleanse and debride the wound properly to remove bacteria and debris
- Control leg swelling, prevent infection, improve nutrition
- Treat any underlying medical conditions
- Choose a dressing that will absorb and protect.
- Provide diabetic foot care education to patients and caregivers
Research has given us an insight into the amazing natural process of healing.
20 years of clinical studies has given us an arsenal of Wound Care protocols and dressings materials that complement the body’s natural healing pathways.
Learn about them and find the right medical team to help you!!
Vocabulary
• Debride – This means to clean off any dead, dehydrated or callused tissue. This will be done initially to be able to fully evaluate the wound and to reduce the chance of infection. It will also be done, if necessary at subsequent dressing changes.
• Cleanse – Using a very mild cleanser or saline
• Absorb – The dressings applied to the wound need to be able to absorb any drainage that the damaged skin is producing. This fluid prevents the new skin cells from growing properly and from adhering to the underlying tissue.
• Protect – The dressing material may need to have a soft top cover and/or you may need special footwear to relieve pressure if your wound is on your foot. Many advanced wound care dressings also protect the wound from outside moisture and bacteria, reducing the risk of infection.
• Control Edema - Swelling in your leg squeezes the blood vessels and prevents good blood flow which is critical to wound healing. Your provider may wrap your leg from the toes up to the knee. The material may look like an Ace Wrap but it will be a special material designed to appropriately control swelling without compromising circulation. You will need to keep this wrap clean and dry. It is also helpful for you to reduce your salt intake and elevate your leg above heart level as often as possible during the day.
As we have discussed many times you will not be changing the dressing yourself. Wound care treatment involves evaluation by trained medical specialists. You will leave the dressing clean, dry and intact until your next visit. If you’re under a protocol where you need to change the dressing you would only be because there is an active infection, which your health care team is fighting. If there is not an active infection or excess drainage that cannot be handled by a dressing left on longer, it is totally inappropriate to change the dressings everyday or several times a day. This was the old protocol from the civil war up to the 1960s. It would be one indication that you may not be working with the right health care team to heal this wound. I do want to state again that either infection or excess drainage which cannot be controlled would be one reason that you would need to change the dressing more often than every three to seven days.
Medical Disclaimer
This information made available through Dr. Julia Overstreet or this web site is not intended to replace the services of a nurse, nor does it constitute a doctor-patient relationship. Information on this web site is provided for informational purposes only and is not a substitute for professional medical advice. You should not use the information on this web site for diagnosing or treating a medical or health condition. Any action on your part in response to the information provided in this web site is at the reader's discretion. Dr. Julia Overstreet or Drjulia.com makes no representations or warranties with respect to any information offered or provided on or through the drjulia.com web site or Dr. Julia Overstreet. Dr. Julia Overstreet or Drjulia.com is not liable for any direct or indirect claim, loss or damage resulting from use of this web site and/or any web site(s) linked to/from it.
What important history will they ask?
Chronic Wound Assessment - a key to proper wound care treatment
Patient Factor
- Identify other illnesses
- Medications
- Evaluate nutrition
- Thorough medical evaluation
Action:
- Get evaluation by specialists
- Treat any underlying diseases aggressively
- Improve nutrition
Wound Factors
- Duration of wound
- Location of wound
- Condition of wound bed
- Infection present?
Action: - Treatments: Cleanse, debride, choose dressing type, swelling control wraps
What happens when the skin is injured?
Skin Damage
- Rubbing
- Tearing
Immediate Changes
- Stop Bleeding (Platelets and clotting factors)
- Prevent Infection (White Blood Cells, Neutrophils)
Healing Begins
- Inflammation : Beneficial
- Debris Clearance ( Macrophages .....)
- New Blood Vessels Begin to Grow
New Tissue Forms
- The New Blood Vessels Bring: Growth Factors, Fibroblasts, Endothelial Cells
- Collagen Interlinks the new Cells into Tissues
- The Tissues Thicken up to Skin Level
Epithelialization (New Top Layer of Skin)
- Epithelial Cells and kerotinicytes form and extend, one by one, across to cover the wound bed.
Remodeling
- All of the new tissues become stronger and more viable.
Wound Care Misconceptions:
- Leave it open to air
- Clean it with hydrogen peroxide or iodine
- Scrub it well to prevent infection
- Dress it with gauze so it can breathe and change the dressing several times a day to keep it clean.
What happens at an appointment at a wound care clinic?
Evaluation
- Photo & Measure the wound
- Describe wound bed (dry, wet, red, yellow)
- Describe wound borders and surrounding skin (red, blistered, curled, white)
- Is infection present?
- Is there any dead tissue that needs to be removed?
- How severe is swelling?
- X-ray for bone infection
Treatment
- Remove any dead tissue or debris
- Cleanse wound appropriately
- Treat any infection
- Choose/apply proper dressing
- Choose/apply edema control method