Wound care

Martina Feichter studied biology with an elective subject pharmacy in Innsbruck and also immersed herself in the world of medicinal plants. From there it was not far to other medical topics that still captivate her to this day. She trained as a journalist at the Axel Springer Academy in Hamburg and has been working for since 2007 - first as an editor and since 2012 as a freelance writer.

More about the experts All content is checked by medical journalists.

Wound care means cleaning, closing and caring for an open injury. Careful wound management is very important, especially with complicated injuries or poor healing. Here you can read everything you need to know about the basic principles of wound care, how you can take care of a wound yourself and when it is advisable to see a doctor.

Brief overview

• What does wound care mean? All measures for the treatment of acute and chronic open wounds - from first aid to complete wound healing.
• Measures for wound care: wound cleaning and disinfection, possibly drainage, possibly debridement, possibly maggot therapy, wound closure with plasters, tissue glue, sutures or staples.
• Wound care: Avoid contact with dirt and water on freshly treated wounds, do not use commercially available soap for wound care, possibly apply wound and healing ointment to support wound healing.
• Risks: wound infection, formation of unsightly scars, with surgical wound care and debridement: risk of nerve and vascular injuries.

Caution!

• Wounds that bleed profusely or persistently should definitely be treated by a doctor. The same applies to heavily soiled wounds as well as large cuts, bites, burns and lacerations.
• Do not try to stop bleeding on your arm or leg by tying it off! You could injure nerves and tissue! Therefore, only medical professionals should bandage a bleeding wound and only if there is a threat of life-threatening blood loss.
• If you have fresh injuries, think about tetanus vaccination! The last tetanus injection should not have been more than ten years ago.

How does wound care work?

The term wound care includes the cleaning, closing and care of open wounds. Such wounds can be both acute injuries (such as cuts) and chronic wounds (such as pressure sores in bedridden patients).

Wounds that have existed for more than two to three weeks are called chronic.

Primary and secondary wound care

Doctors differentiate between primary and secondary wound care:

Primary wound care

This means that the wound is closed within the first six hours after the injury. Sometimes a plaster or tissue adhesive is sufficient for this, for example in the case of wounds on areas of the skin that are not subject to mechanical stress. In other cases, the wound must be closed with sutures or staples.

Secondary wound care

In some cases, primary wound care is not possible. This applies, for example, if a wound is inflamed (infected) or if it is a chronic wound, for example pressure sores (decubitus) or diabetic foot. If you were to close such a wound directly, the pathogens present in it could easily multiply and cause a serious infection.

Therefore, such an injury initially remains open and is cleaned regularly. Only when the wound is clean (usually after several days, but sometimes not until weeks) is it closed with a suture.

Wound care: moist or dry

With dry wound treatment, open wounds are covered with a sterile, dry wound pad. In the case of poorly healing wounds and burns, on the other hand, it makes more sense to use special pads that keep the wound area moist. This moist wound care (moist wound treatment) is also called modern wound care because specially manufactured materials that have been newly developed in recent years are used for it.

You can read more about the different dressings and their use in the article Wound Care: Wound Dressings.

First aid

The beginning of every wound care is the initial care of the wound. It is important for further treatment and good wound healing.

In the case of smaller wounds in particular, first aid can also be carried out by a layperson, for example by the patient himself or by the parents (in the case of children with small wounds). A medicine cabinet or an emergency kit should be available in every household and car with the following content:

• mild disinfectant, suitable for open wounds / mucous membranes
• sterile swabs and compresses
• commercial plasters as well as fixing plasters
• Gauze bandages and bandages
• scissors

The first treatment for a bleeding wound is about hemostasis. You can stop weaker bleeding by applying several sterile compresses to the wound and then wrapping the wound with a gauze bandage with light pressure.

If the bleeding is heavier, after the first wraps of the gauze bandage you should also place a bandage pack over the wound and wrap the rest of the gauze bandage tightly around it (pressure bandage). The extra pressure can compress the blood vessels. It is also advisable to elevate the affected part of the body. If the bleeding still cannot be stopped, you must call a doctor immediately!

Setting

In the past, when there was heavy bleeding from arterial blood vessels in the arms and legs, it was recommended that the extremity be tied to stop the bleeding. However, there is a risk that the bound limb will be completely cut off from the blood supply - this can result in tissue death. In the worst case, the affected leg or arm must then be amputated!

Therefore, the tying of wounds is now only recommended if there is a threat of life-threatening blood loss. In addition, if possible, it should only be performed by healthcare professionals.

In situations in which surgical hemostasis is difficult (e.g. in military medicine), tying continues to be of great importance.

Superficial wound

If the injury is superficial, primary wound care is indicated. This can usually be done by the family doctor or pediatrician:

First, he examines the wound in detail. Among other things, he checks how deep the injury is. Then he starts cleaning the wound: To do this, he uses, for example, saline solution for coarse soiling and then a mild disinfectant that does not burn as strongly. So that the wound can heal well, he now brings the wound edges together with cling plasters or special tissue glue. If the clean wound edges are next to each other, the injury can heal well.

Deep wound

If the doctor determines that the wound is a deep, complex injury during the wound assessment, he will proceed as follows for the primary wound care:

• First, he must clean and disinfect the wound, as is indicated for superficial injuries.
• Then he can close the wound: Sometimes a special tissue adhesive is sufficient for this. In other cases, he will have to stitch the wound or use a special stapler to staple the wound. So that the patient does not experience any pain, the doctor injects a local anesthetic near the wound beforehand.
• If the wound is bleeding profusely, the doctor often places a drainage before the wound is closed: Wound fluid and blood are sucked out of the wound area through a thin plastic tube using negative pressure. The drain is then removed a few days later.

Chronic or inflamed wound

An inflamed wound, like a chronic wound, requires secondary wound care. This is how a potentially life-threatening wound infection can be prevented:

The doctor first cleans the wound with saline and then rinses it out. He uses an antiseptic solution for this wound irrigation. So-called debridement is usually also carried out: the doctor cuts out infected or damaged tissue from the edge of the wound and from the depth of the wound. This prevents wound infection and stimulates the remaining tissue to heal.

The final wound closure only takes place when there is no (longer) infection and the newly formed tissue looks healthy.

Dressing change

If a wound was bandaged during initial treatment, the dressing should be changed after 24 to 48 hours at the earliest. In the case of chronic or inflamed wounds, this should be done by a doctor or nursing staff. You can lend a hand yourself for smaller wounds. You can find out what you should pay attention to in the article Wound Care: Dressing Change

Wound and healing ointments

There are different ointments that can support wound healing. For example, some contain the active ingredient dexpanthenol. It promotes the renewal of the skin layer and provides moisture. You can read more about ointments for wound care and their correct application in the article Wound Care: Wound and Healing Ointment.

After wound care

After treating the wound, you should pay attention to a few points so as not to disrupt the healing process:

• After treating the wound, make sure that the wound is not soiled and does not come into contact with water. You can stick a special waterproof plaster on for showering.
• You must not use commercially available soaps for wound care.
• If your wound has been sutured, you should see your general practitioner or doctor treating you after ten to twelve days to have the stitches pulled. If it is a wound on the face, you can have the sutures removed as early as the fourth to sixth day.

Wound care: maggot therapy

In the case of poorly healing wounds, doctors sometimes rely on the help of maggots: fly larvae are introduced into the wound. The maggots that hatch from it eat dead cells and can thus promote wound healing. You can read more about this form of therapy in the article Wound Care: Maggot Therapy.

When do I do wound care?

Every open wound should be properly treated. For smaller wounds, you can do this yourself:

Care for lacerations

A laceration is a superficial injury that occurs as a result of blunt direct violence (for example, a fall while cycling, skateboarding or climbing). The edges of the wound are often torn, which can impair wound healing. With the right wound care, you can prevent this from happening. You can find out more about this in the article Wound Care: Laceration.

Care for abrasions

Abrasions are - like lacerations - frequent injuries in everyday life and during sports. They occur when the skin scrapes over a rough surface, such as the asphalt when a bicycle falls. As painful as such abrasions are, they are usually only very superficial and harmless. Nevertheless, they should be properly cleaned, disinfected and covered. You can find out how to do this in the article Wound Care: Abrasions.

Care for cuts

Slipped the kitchen knife briefly and you've cut your finger! Or you step into a shard of glass while walking barefoot. If it is a minor cut with closely spaced wound edges, you can easily take care of the wound yourself. You can find out more about this in the article Wound Care: Cut.

When is a doctor's visit necessary?

In the following cases you should see a doctor promptly so that he can perform professional wound care:

• profuse or insatiable bleeding
• large cuts, bites, burns or lacerations
• heavily soiled wounds that cannot be cleaned with disinfectants alone

Wound Care Risks

The goal of wound care is to reduce the risk of infection and impaired wound healing. However, as with almost any medical therapy, something can go wrong. For example, the injury can become infected despite wound treatment. This can be recognized by pain, redness, swelling and pus secretion in the wound area.

In addition, unsightly scars can form in the course of wound healing. In some cases these grow excessively and even cause pain (hypertrophic scar or keloid scar).

With surgical wound care and debridement, there is a risk of damaging adjacent tissue, nerves or blood vessels.

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