Understanding Skin Wounds

Our protective armor, skin, is the largest organ in the body. But armor only, skin is not. This highly dynamic network of cells, nerves, and blood vessels serves the body in diverse ways.

Clearly, skin's protective function is paramount, providing internal organs and tissues with a physical barrier from the environment and the dangers therein: toxins, heat and cold, and disease-carrying microbes. But skin also plays an important role in preserving fluid balance and in regulating body temperature and sensation. Nerves buried deep within skin allow us to sense the presence of potentially harmful invaders, such as bees. Immune cells resident in skin help the body prevent and fight disease.

For these reasons, the loss of skin due to burns or trauma can deal the body a severe blow, impairing or even eliminating the many vital functions this organ performs.

In spite of recent advances in the basic mechanisms of wound healing, knowledge of factors involved in the development and treatment of chronic wounds and their prevention remains limited.

A number of reports have established that the application of growth factors to acute experimental wounds in animals enhances healing. However, it is unclear what role growth factors play in chronic wounds. Indeed, recent clinical trials of topical application of single growth factors to pressure, venous and diabetic wounds have not been very encouraging. It should be appreciated that growth factors are multifunctional with both stimulatory and inhibitory actions depending upon cellular context.

In normal skin, the basal cells are attached to the basement membrane and lose anchorage upon skin injury. The signals responsible for epidermal migration after wounding are unknown, but keratinocytes begin to migrate toward the site of injury. The "tractor tread" hypothesis, whereby keratinocytes stop at the wound bed with progressive climbing of proximal cells over the now resting cells has gained wide acceptance as a model of keratinocyte migration. Investigations of the epidermal edge of venous ulcers has shown that the epidermis displays mitotic activity, resulting in increased epidermal thickness at the edges of chronic wounds. This has led to the hypothesis that a fundamental defect exists in the chronic wound situation, perhaps a failure of cells to adhere to one another or their substrates. There has been substantial recent information on the signals for keratinocyte movement and substrate requirements at least in the context of acute injury. The concept that the extracellular matrix is an integral part of keratinocyte migration has also received experimental support. Migration enhancing and inhibiting molecules found in extracellular matrix and/or in wound beds have been described.

For the last several years, evidence has suggested that chronic wounds may be growth factor deficient or represent a microenvironment hostile to the repair process. More recently, however, there is new evidence suggesting that wounds may not necessarily be deficient in growth factors, but that the stimulatory action of the peptides may be prevented from being expressed.

Scrapes and abrasions are superficial injuries to the skin and mucous membranes. Although scrapes and abrasions are relatively minor injuries, like all open wounds they are painful and highly susceptible to infection. Following an abrasion or scrape, a physician should be consulted about antitetanus injections. If dust and grit are left in the wound, scars may form on the skin. Any foreign matter should be removed before the wound has healed.

Clean the abrasion with soap and water, and rinse thoroughly. If the victim has other injuries or extensive abrasions, summon medical aid. Do not remove any scabs that may form over the injury. They will fall off when the wound has healed. If scabs are removed before the wound has fully healed, the abrasion may begin to bleed again.

The list below includes wound care medications and other helpful items. Remember, if you have a serious injury or illness, you should seek professional medical attention.

  • Analgesic - preferably acetminophen
  • Antacid
  • Anti-inflammatory - preferably Ibuprofen
  • Calamine lotion
  • Expectorant cough syrup
  • Decongestant (pseudoephedrine)
  • Ointment
  • Antiseptic solution (Hydrogen Peroxide)
  • Petroleum jelly
  • Sunscreen (SPF-15 or higher)

Wood sage, chickweed, goldenseal, myrrh, echinacea, slippery elm are effective as poultices and/or washes.

See also: Wounds

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