Wound care definition

The core definition of wound care is to target various types of acute and chronic skin/mucosal tissue defects, covering the entire cycle from the occurrence of damage to complete epithelialization. Through a series of professional operations such as assessing the wound status, intervening in the healing microenvironment, preventing and controlling complications, and reducing scar hyperplasia, it is a clinical practice system that shortens healing time, reduces the risk of functional injury, and improves the patient's quality of life. It is by no means as simple as "applying an iodophor band-aid" as the general public thinks.

I don’t say this casually. I just met a 19-year-old boy in the clinic last week. He fell on his knee while riding a shared bicycle, and a large piece of skin was rubbed off. He changed the Band-Aid every day at home. After three days, the edges of the wound were soaked with exudate and turned white. He even said aggrievedly, "I obviously disinfect and change the bandage every day, why is it more serious?" This is a typical narrowing of the understanding of wound care.

At this point, I have to mention the debate over direction in the field of wound care that has been quarreling for almost half a century: the older generation always said that wounds should be left to dry and scab over to heal quickly. This is actually the core of the traditional dry healing concept. When there were no suitable dressings and poor disinfection conditions a few decades ago, it can indeed reduce the probability of infection. It is still applicable to small abrasions with no contamination and extremely shallow wounds; while the wet healing concept, which has become increasingly popular in the past 30 years, advocates that Keep the wound surface at an appropriate humidity under sterile conditions, and it will be directly epithelialized without scabbing. The healing speed can be about 30% faster, and it can also reduce scarring. Now it has become the mainstream of chronic wound and surgical incision care; there are many clinical Practical nurses have been promoting the idea of "combination of dry and wet" in the past two years. The contact layer of the wound is covered with wet dressings to lock in water, and the outer layer is used with breathable dry dressings to keep out dust and waterproof. This is equivalent to building a small house with constant temperature and humidity for the wound surface, which is particularly practical. You can compare the new cells on the wound surface to vegetable seedlings that have just emerged. The dry and hard scabs are like hardened soil, and the seedlings cannot move at all. The suitable moist environment is loose and watered soil, and they will naturally grow faster.

Don’t think that wound care is only about the broken skin. In the past two years, I have met too many elderly people with diabetic foot. Their wounds have been rotten for several months, and they are so worried that they can’t eat. Every time we change dressings, we have to chat with them for ten minutes to comfort their emotions. The psychological pressure caused by wounds that have not healed for a long time will in turn slow down the healing speed. Therefore, current wound care has long taken into account psychological counseling, subsequent functional recovery, and even the aesthetic management of scars. The boundaries are much wider than everyone thinks. Last month, a girl had double eyelid surgery. After the sutures were removed, she came over and asked how to care for the incisions so that they would not grow. We gave her silicone gel and taught her how to massage her. She recovered so well in the end that even her mother didn’t see any traces of the incisions. Ten years ago, who would have thought that post-operative care for double eyelids was considered wound care?

To be honest, the longer I work in this field, the more I feel that there has never been any unified standard operation for wound care, and the core is always "depending on the person's preferences": a superficial abrasion can be healed in two days without the need for expensive dressings, an elderly bedridden patient with pressure sores must turn over regularly and apply negative pressure drainage, a beauty-loving girl must take care of scar removal after surgery, and an elderly person with underlying diseases must control blood sugar before healing. To put it bluntly, what we do is not to care for wounds, but to help every injured person put his damaged life back together bit by bit.