Treating Wounds

A wound is a break in the tissues of the body. Some injuries, like cuts and scrapes, are called open wounds; others, like deep bruises, are called closed wounds. They are usually caused by external forces such as motor vehicle accidents, falls, and the mishandling of sharp objects, tools, machinery and weapons.

All wounds need first aid (and medical attention if the wound is serious) in order to ensure proper healing and to avoid infection.

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.

Matrix degrading proteinases are proenzymes that need to be activated and are considered to be the physiologic mediators of matrix degradation. The prototypic one is interstitial collagenase, but there are at least ten of these enzymes that are secreted as zymogens. Stimulated by growth factors and by extracellular matrix, they all utilize zinc with a zinc atom binding at the center of the molecule at a conserved sequence. They are stabilized by calcium and inhibited by various chelators such as the tissue inhibitor of metalloproteinase. It is clear that collagenases are present in acute wounds, but little or nothing is known about their possible role in chronic wounds.

Chronic wounds, including pressure ulcers and venous ulcers, are characterized by the presence of fibrin within the wound bed and surrounding tissues. Fibrin accumulation in acute wounds is removed within days, but it is not degraded in chronic wounds. Knowledge of the process of fibrin formation and polymerization that has accumulated in recent years may provide the basis for understanding the persistence of fibrin in chronic wounds. The role of fibrin retention and the adherence of other molecules to it in interacting with cytokines and growth factors in the wound healing process have just begun to be investigated.

An important focus of wound healing research is the improvement of patient care through the interdisciplinary collaboration between clinicians and basic scientists. Restoration of physical integrity and function of the injured or diseased tissue can best be accomplished by integrating bio/molecular technology with clinical treatments as clinicians and basic scientists work together. Examples to encourage opportunities for clinicians to collaborate with basic scientists include:

  • Investigations designed to determine the biological or molecular reason for successful wound healing with currently used clinical therapies, such as electrical stimulation, laser, or nutritional regimens. For example, clinicians have reported faster healing of pressure sores with patients on high protein diets. In order to identify the pivotal amino acid, methionine, cysteine, or arginine might be studied. Because zinc is a necessary cofactor of DNA polymerase and reverse transcriptase, studies could be pursued to determine whether or not the healing impairment associated with zinc deficiency is due to an inhibition of cellular proliferation.
  • Investigations designed to identify specific biological/molecular markers that could be used to define standardized outcome measures. For example, various dressings such as hydrocolloid, polyvinyldiene, polyethylene, polyurethane, and human skin are used in health care facilities to increase the rate of epithelial healing. Can serum protease inhibitors or tissue inhibitors be identified in the fluid of chronic wounds to standardize use of specific wound cleansers and dressings in the treatment of pressure sores/venous leg ulcers?

Serious complications may occur to neglected wounds and, at times, even the best cared for wounds. If you notice any of these signs when examining your wounds, you should see a doctor immediately:

  • Redness, excessive swelling, or tenderness in the wound area
  • Throbbing pain or tenderness in the wound area
  • Red streaks in the skin around the wound or progressing away from the wound
  • Pus or watery discharge collected beneath the skin or draining from the wound
  • Tender lumps or swelling in your armpit, groin or neck
  • Foul odor from the wound
  • Generalized chills or fever

Always wash your hands with soap before and after giving first aid in order to avoid infection.

The following types of wounds are more likely to become infected: bites, punctures, crushing injuries, dirty wounds, wounds on the feet, and wounds that do not receive prompt medical attention.

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; effective as poultices and/or washes.

See also: Skin Wounds

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