Wound Management

Introduction

Wounds are something that everyone of any age can relate to, from the child who grazed his knee in the park to the mother who accidentally cut herself with the kitchen knife. Most wounds that we encounter are superficial wounds that can be treated at home. Left unattended however, even minor wounds leave us vulnerable to infections due to the risk of germs getting into the body. Therefore, it is important to care for the wound promptly and carefully.

Signs & Symptoms

The symptoms of each wound would depend on the type and severity of the wound. In general, symptoms of wounds would include the following:

Bleeding
Pain
Redness and swelling
Decreased mobility and function

When to Seek Medical Attention

Please see your doctor if you:

Are on long term medications that include steroids, blood thinners or chemotherapy.
Are diabetic, or have any bleeding disorders.
Were cut by a dirty object. A tetanus shot might be necessary.
Have a wound that is deep, wide, with skin flaps or with jagged edges.
Wounds caused by animal bites, dirty surfaces and crushing forces tend to be infected more easily. Some signs and symptoms of infection are:
- Warmth
- Swelling
- Pus
- Foul odour
- Red streaks that extend from the wound

Causes

The causes of wounds can be categorised by the type of wound, with the most common ones experienced at home being:

Incision:
- Caused by a sharp object
- Wound with smooth edges

Abrasion
- Caused by scrapping against a rough object
- Usually a superficial wound

Punctures
- A deep but narrow wound caused by a pointed object
- Might appear to close up on the surface

Management

The main principles of wound management would be:

Remove yourself from any possible danger (e.g. turn off the stove in the kitchen). Examine the wound. Stop any bleeding by applying direct pressure on the wound. If need be, elevate the wound above heart level.
Clean the wound with clean water or saline solution. This can also help to wash out any foreign bodies. If necessary, use sterilised tweezers to remove any visible particles. Get help from a healthcare professional if you are unable to do this yourself.
Apply an antiseptic if necessary to prevent infection. All these antiseptics should not be used in the eyes, throat or ears unless directed by a doctor. Some antiseptics include:
- Hydrogen Peroxide produces an effervescent, or bubbling, action which can help to remove debris stuck in the wound.
- Potassium Permanganate and Gentian Violet are dyes that can help to kill germs. It can be used on cuts and wounds, or diluted to be used as a soaking bath for conditions such as athlete’s foot. Always follow the manufacturer’s instructions on the product, and do not bandage unless advised to do so. Be careful when exposing this chemical to clothing or furniture as it can cause permanent staining.
- Proflavine is an antiseptic dye used to stop the growth of certain bacteria at the site of the wound. It can be used in the treatment of superficial wounds and burns, although it should not be used long term.
- Chlorhexidine is available in both wound washes and creams for wound care. It is also used in a mouth wash to treat wounds in the mouth. Chlorhexidine is rather gentle to the skin and can help to prevent infections. Its duration of action is about five to six hours.
- Sodium hypochlorite can be used to kill germs. It has been used as a cleanser and in wound dressings, but can be harmful to new skin tissue. Hence, do not use it for longer than a week without medical supervision.
- Iodine and derivatives like povidone-iodine can also be used for skin disinfection and wound cleansing by targeting a broad spectrum of germs. Like potassium permanganate and gentian violet, iodine can also cause staining and care should be exercised. Povidone-iodine is a complex that releases iodine as it is used up at the site of the wound, hence prolonging its duration of action. It also causes less skin irritation and staining than iodine tincture. Like all over-the-counter antiseptics, long term use is not recommended. Iodine should not be used in people who are sensitive to iodine, pregnant ladies, young children and people with thyroid disorders.
- Silver is available over-the-counter as a dressing form, or as a cream under prescription only. These are used to prevent infection in chronic wounds and burns.

Dress your wound if necessary. Keeping the wound moist can aid healing. Change the dressing regularly and get the wound examined by a doctor if any signs of infection occur. Do not reuse dressings.

Lifestyle Modifications

Prevention is always better than cure. The following might help, especially if you have pre-existing conditions that can interfere with wound healing:
- Make sure there are non-slip mats and bars installed in the bathroom.
- Ensure house is clutter-free to prevent falls.
- Get rid of slippery surfaces such as rugs.
- Be extra careful when handling knives. Store them properly and keep them out of reach of children. Do not leave them on a surface where they might fall off.
- Do not leave a lit stove attended.
- Do not cook with long, loose clothing or chunky accessories.

Have a well-stocked first aid kit at home and check on the expiry dates of the products regularly, replacing them when necessary.
Eating a proper diet can help to give the body adequate nutrients for healing. Eat a diet rich in zinc, protein and vitamins.
Abstain from smoking and excessive alcohol consumption, which can delay wound healing.

Treatment options

Paracetamol or Nonsteroidal Anti-inflammatory Drugs (NSAIDs) can help to make you more comfortable if the pain is unbearable. However, NSAIDs like aspirin can cause blood thinning, so exercise caution and check with your healthcare professional if you are unsure.
Use an antiseptic (See section “Management” above) if you are concerned that the wound might get infected.
Antibiotics might be prescribed by a doctor if there is a high chance that your wound might become infected, or if infection has set in.