Wound Care medicine

Got some minor cuts and scrapes while doing water sports (not the fetish kind you perv), was curious about the optimal way to dress them, which lead to reading at least a dozen papers and articles on wound care and dressing selection.

It is a complex and interesting topic! Here is my probably-inaccurate summary:

The four stages of wound healing are hemostasis, inflammation, proliferation, and maturation.

Hemostasis is the body's immediate reaction to and stabilization of the wound. Blood clots and stops flowing from the wound. Or doesn't, in which case hemostasis is the first and last stage of wound healing.

Inflammation comes next, which includes processes that prevent infection and initiate healing. Injured blood vessels leak transudate (water, salt, and protein) white blood cells head to the wound, tissue turns red and swells, and bacteria and dead cells are removed from the wound.

Proliferation is the phase where the bulk of tissue reconstruction and healing takes place. Lost tissue grows back, and the wound closes. In the final phase of proliferation, epithelial cells regrow and cover the wound.

Maturation, also called remodeling, is the finalization and cleanup phase. The plumbers, electricians, and carpenters leave the building site, and all the loose ends are tied up. Temporary cells die off via apoptosis, and the new tissue reorganizes and strengthens.

The appropriate dressing depends on the characteristics of the wound, and so, as you might imagine, there exists a rich terminology for wound description.

A sloughy wound is with a layer of infected gunk, usually yellow, You've probably noticed this when you've had an infected scrape. Slough is dead tissue that must be removed for the wound to heal, and a sloughy wound should be covered with a moist dressing that allows the slough to liquefy. I gather that mechanical debridement of slough, e.g. the use of wet-to-dry dressings, although still widely used, is no longer a standard of care.

A necrotic wound has some amount of dead skin or flesh covering or surrounding the wound, usually of a ghastly black color. If necrotic tissue is badly infected, it should be surgically removed. However, since this is invasive and destructive, the preferred alternative for the removal of non-infected necrotic tissue is the use of a moist, occlusive dressing promoting autolytic debridement, the natural separation of viable and non-viable tissue.

A granulating wound wound in the process of healing. It has a nice bright, healthy red color, and should be covered in a moist occlusive dressing and left to heal.

An epithelial wound is in the final stages of healing, with new skin growing over and covering the wound.

Interesting tidbit, if a wound is deep, it should be packed with some kind of dressing, to prevent premature wound closure before the wound void fills in with new tissue.

For my own rather boring although mildly sloughy wounds, I went with hydrocolloid dressings. Hydrocolloid dressings are occlusive dressings which create a moist environment for wound healing. As they transition from sloughy wounds to granulating wounds, I might switch to just using a film dressing, which are more flexible, comfortable, and durable.

After all this, I'm a little bummed that I don't have much weirder, graver, more complicated wounds that would demand more complex and interesting care. 😂