The Truth About Wound Care

We’ve all had skin injuries and wounds at one time or another, either as children, but probably as adults as well – ranging from paper cuts to diabetic foot ulcers.

What are we supposed to do for our skin injuries and wounds? Have mom kiss them and make them better? Soak them in turpentine? Heat up a piece of iron and sear them?

Get a couple of leeches to attach and help healing? (Yes, people still do that!) Pour some Jack Daniels whiskey into them after taking a swig of it first?

Well, all those options are probably not the first-line of good medical care. First things first. Make sure you are up to date on tetanus.

If you haven’t had a tetanus booster in the past 5 to 10 years, stop what you’re doing right now and go get one. Tetanus is an easily avoidable debilitating disease that is actually quite common.

Once that’s taken care of, let’s build out what you need to take care of most skin injuries and wounds. For the sake of clarity, remember that not all injuries are wounds and not all wounds are injuries.

Injuries are defined by the application of force to the skin that results in damage to that tissue.

An injury can be a cut or tear of varying depths (laceration), a bruise (contusion), penetration, or a scrape/scratch (abrasion) that may scrape off the superficial layers of skin and cause bleeding, but doesn’t go all the way through the dermis or bottom layer of skin.

A wound, on the other hand, is damage to the skin that results from an injury like those above, or from the limitation of blood flow to that tissue causing an ulceration (like from chronic pressure – bedsores or vascular disease – diabetic wounds).

After making certain your tetanus is up to date, it’s time to build out a reliable first aid kit for injuries and wounds. I’d suggest several basics – antiseptics, anesthetics, antibacterials, bandages, and Superglue (cyanoacrylate).

I wouldn’t initially worry about suture, but as you build out your kit, you may want to consider a few key pieces that I’ll mention below.

When we consider antiseptics, we want to include one or two things that kill bacteria and help a wound heal without getting infected.

Some examples would be things like isopropyl alcohol, Betadine (povidone-iodine), mercurochrome, hydrogen peroxide, chlorhexadine, Bactine, or the like.

Alcohol is great – especially for uninjured skin prep, but it hurts on open wounds and it damages tissue.

Betadine is an iodine solution that is very effective on uninjured tissue, but is messy and will permanently stain clothing.

I also don’t like using it on open wounds because, like alcohol or peroxide, it can damage healthy tissue.

Mercurochrome is very useful and has been used extensively in years past, but has fallen out of favor because of the temporary tissue staining and because of fears of the small amounts of mercury though they be negligible.

In fact, it’s nearly impossible to find in the United States anymore. Hydrogen peroxide is a wonderful antiseptic, but again has the potential to damage healthy tissue that’s been injured. I still like small amounts for wound cleansing given its strong bactericidal properties.

So, we’re down to the two safest and most useful – chlorhexadine and Bactine or benzylkonium chloride. These are nearly painless and very effective at cleansing wounds, killing bacteria and preserving the injured tissue without causing further damage.

The problem with damaging tissue is that it provides dead organic material for bacteria to feed on without the benefit of immune system protection.

Anesthetics are nice, but not essential. Bactine now contains lidocaine which is an effective anesthetic.

You may also want to add a compound with pramoxine to your armamentarium. Though not as effective as lidocaine or benzocaine, it still provides pain relief.

I’d make sure you had antibacterial cream or ointment. Remember a cream is water soluble and an ointment, since it is petroleum based, is not.

Some examples of antibacterial creams and ointments are things like triple antibiotic ointment, Neosporin, Bacitracin, and the like.

They are all good, though the neomycin in the Neosporin may be more likely to cause skin reactions due to allergy, but it also contains the bacitracin that Bacitracin contains plus polymixin B – so it is a true triple threat.

Make sure you have a selection of various types and sizes of bandages – bandaids, 2x2s, 4x4s, Telfa (nonstick bandage) paper tape, and possibly Tegaderm (an occlusive film bandage).

You may also want to include a small pair of good bandage scissors – avoid the cheap ones – you’ll thank me later, and a couple of small rolls of Coban (self-stick bandage roll), and/or a couple of small ACE bandage rolls.

Finally, grab a small tube or two of superglue. Yes, you can use it to seal and protect a wound.

If you decide to use it, be careful to not mistake it for eye drops or eye ointment (I’ve seen that happen way too many times), and be careful not to get it in the wound.

Simply pull or press the wound together and place a small amount on the skin across the wound to hold it together.

You may have to hold it closed for a few minutes until the glue dries, but take care to not glue your fingers to the wound.

Now, speaking about wounds such as ulcers, diabetic wounds or large gaping wounds. Instead of trying to close these, you’ll want to pack them with gauze. Wet if the wound is dry and dry if the wound is wet.

If you wet the gauze, it’s actually better to use tap water than sterile water because of the chlorine and fluoride in the water which act as bactericidal (kills bacteria) and bacteriostatic (inhibits bacterial growth) agents.

Something that you may consider, and this is really cool – combine a bunch of granulated sugar with a very small amount of Betadine in order to make a paste. Apply this inside a wound to encourage healing and minimize infection risk.

The osmotic gradient created by the sugar pulls healing fluids into the wound while the Betadine keeps it bacteria-free. It really works.

If you want to learn how to suture or if you want to just have some just in case, I’d suggest you have a large permanent suture like a 0 or a 1-0 nylon (Ethilon) on a large curved needle just to reapproximate larger wounds. You could also pack and/or wrap them tight and seek medical attention.

Now, if you’re going to suture, please stay away from cheap suturing tools and buy the more expensive German-made iris scissors, needle-holder, and forceps.

It’s simply not worth the frustration of dealing with the cheaper ones as they fail often.

As you can see, you don’t really need that much to have a basic first aid kit to take care of skin injuries and wounds.

However, as we’ve previously discussed on several occasions, make sure you have a tourniquet or two. It may truly save your life or the life of one you love.

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