Yes, the title pretty much says it all. Wound care. What inspired this post, one may ask. Well this inspired a post on wound care.
*Disclamer: Not for the faint hearted*
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Post Fall (5 Days Knees)...
Still raw and slightly infected...
Still raw and slightly infected...
Yes, i am embarrassed to say this but i fell and I fell real hard and I fell real bad. At some point of time, i believe, everyone will have their fair share of bumps and bruises, falls and cuts. Well, scraped knees is definitely one of them, and yes i know it can be a bitch. It hurts. It render you unmovable. Most of all it takes ages to heal. Scraped knee is a hard place for wound healing. This is because the knee is constantly bending and moving as we move about *Duh*. Although, scraping knees is a seemingly minor injury, it can be extremely painful and worst if not handled properly infection may sink in. Worst of all obvious scarring might happen.
Healing of scrapped knee is a difficult process. You are likely to put stress on it during healing period and it might take up to 15 days for scabs to form. Through this experience, i realised that my personal knowledge of wound care is pretty limited and inadequate. As such, i hope this post will help many out there who just had a fall, or you who stumble on this post while google "scrapped knees".
Step #1: CLEAN THE WOUND
Clean the knees well.
Run your skinned knee under water and wash it under RUNNING WATER WITH MILD SOAP.
(Yes, it will hurt...)
But this step is very important.
Skinned knee often trap superficial dirt, gunk and other foreign particles on surface of the wound (or even deeper than that). As such, clean out the wounds appropriately. Wash it. Remove the dirt gently with a soft cloth, fingers or tongs.
** If wound is deep and require sutures, please see a doctor immediately **
Run your skinned knee under water and wash it under RUNNING WATER WITH MILD SOAP.
(Yes, it will hurt...)
But this step is very important.
Skinned knee often trap superficial dirt, gunk and other foreign particles on surface of the wound (or even deeper than that). As such, clean out the wounds appropriately. Wash it. Remove the dirt gently with a soft cloth, fingers or tongs.
** If wound is deep and require sutures, please see a doctor immediately **
Step #2: ANTISEPTIC
Apply some ANTISEPTIC OINTMENT.
While many of you would be tempted by applying betadine, chlorohexadine or hydrogen peroxide. But you might want to think twice before doing it. Betadine and Chlorohexadine should not be used as they are non-selective and cytotoxic. Recent research has also shown that using hydrogen peroxide as an antiseptic on the skin isn't such a good idea, and in fact can actually damage the tissue surrounding the wound. Physicians at the Mayo Clinic agree that hydrogen peroxide can be damaging to the delicate tissue surrounding the area where the product is used, as several studies have been conducted by Mayo researchers in order to determine the effect of hydrogen peroxide on cuts, scrapes and abrasions. Although there are mix outcome in the research of hydogen peroxide, i suggest to just aviod using it!
Just apply some form of antiseptic cream (e.g. common dettol antiseptic cream $4.50 @ watson or any other brands). These creams are sold over the counter and generally contain either streptomycin or penicillin antibiotics capable of killing bacteria that cause infections. While some others may contain mild anesthetic that relieves minor pain. This step is important to inhibit growth of microorganisms. (You don't want to risk an infection...)
While many of you would be tempted by applying betadine, chlorohexadine or hydrogen peroxide. But you might want to think twice before doing it. Betadine and Chlorohexadine should not be used as they are non-selective and cytotoxic. Recent research has also shown that using hydrogen peroxide as an antiseptic on the skin isn't such a good idea, and in fact can actually damage the tissue surrounding the wound. Physicians at the Mayo Clinic agree that hydrogen peroxide can be damaging to the delicate tissue surrounding the area where the product is used, as several studies have been conducted by Mayo researchers in order to determine the effect of hydrogen peroxide on cuts, scrapes and abrasions. Although there are mix outcome in the research of hydogen peroxide, i suggest to just aviod using it!
Just apply some form of antiseptic cream (e.g. common dettol antiseptic cream $4.50 @ watson or any other brands). These creams are sold over the counter and generally contain either streptomycin or penicillin antibiotics capable of killing bacteria that cause infections. While some others may contain mild anesthetic that relieves minor pain. This step is important to inhibit growth of microorganisms. (You don't want to risk an infection...)
Step #3: DRESS YOUR WOUNDS
APPLY APPROPRIATE BANDAGES/DRESSINGS
Yes
you see it right. APPLY DRESSING. I know many of you must be thinking, does
this person know what she is writing?
People,
I know what I am writing. I am sure many of you were told by your grandparents,
parents or other hand-me-down old wives recommendation that wounds should be left
open to air, which speeds up the healing process.
BUT
keeping the wound clean, moist and
covered as opposed to open and dry helps wounds heal more quickly and
efficiently. In a study published in 1995 – The Journal "Dermatology
Surgery" found that covering a wound prevents drying. This enhances new
skin formation. Another study in the February 2007 issue of "Emergency
Medicine Clinics of North America" reported that covering a wound
maintains moisture, enhancing the healing process and reducing pain and
scarring. In order for your wound to form new skin tissue, new cells need to
form. And cell growth thrives in moist environments! The principle of moist
wound therapy is to create and maintain those optimal moist conditions for your
skin to renew itself. This is known as moist healing. Wound healing begins when blood clots eventually
forming a scab. Under the scab, skin cells and blood vessels begin to
reconstruct the damaged tissue. Although the scab closes off the wound and
protects it, actually impedes the growth of new skin cells in to cover the
wound. Therefore, the best way to protect a wound and to guarantee that it
heals well is to cover it with a thin film of anti-bacterial ointment or
petroleum jelly. This creates a protective layer which keeps the air out, prevents extensive scabbing, and speeds up the migration and growth
of new skin cells into the area.
From
my personal experience recently, a mixed approach could be adopted. I personally
felt that it would really help to cover up your wounds during the first few
days of your fall to prevent further aggravating the wounds (i.e. scraped
again!) and keep the wound moist. Perhaps after 4-5 days, you could leave the
wound open to dry. But please bandage your wound when you sleep so that your
wound wouldn’t stick to your beddings.
** This is just my personal experience **
Step #4: POST CARE
I realized for many websites, post
wound care was not mentioned. Post wound I mean what happens after your wound
has healed? I think for many people, the issue of scarring is something that we
always fear. This is especially true for the ladies (those with special
relationship with short dresses, skirts and shorts!)
Therefore, I feel that
post care is also very important.
When I fell, it wasn’t so much the
pain first. But my first sentence to my brother was “this will definitely scar”.
As such, I really research and try to minimize scarring.
As seen in this section, I have
attached 2 pictures (Dermatix and BIO-oil), which I have used during this
period. I suppose BIO-oil do not need much introduction. BIO-oil contains the
ingredient PurCellin Oil, which helps to reduce scar and has anti-aging
function. Dermatix was introduced to me by our friendly neighbourhood Guardian
pharmacist when I was looking for silicone gel sheets. Dermatix is a silicone gel,
which comes in a soft gel format which is lightweight, non-greasy, and applies
to the skin smoothly and evenly. It is used to help prevent scars in freshly healed
wounds and also reduce prominent immature scars. It is clinically tested and
proven to soften, flatten and smooth scars, and relieve the itching, pain and
discomfort associated with them.
A lot of research has focused on how silicone gel
and the wound healing process works. To heal properly, as mentioned earlier a
wound needs an environment that is neither too dry nor too wet. Silicone gel
provides such an environment. A silicone layer allows the skin to breathe
without letting it dry out, helping with fibroblast production while keeping
collagen production under control. Scar
tissue is a result of excessive collagen during the healing process. The
silicone gel covering on the wound helps ward off bacterial infection, which
can induce excessive collagen production and give rise to unsightly scar tissue.
Wound healing requires both the production and breakdown of collagen in the
skin with the aid of natural chemicals called growth factors. Silicone is able
to modulate the levels of different growth factors, controlling both collagen
production and the breaking down of excess collagen. Silicone works by
restoring the balance that is essential for healing the wound without excessive
levels of scar tissue.
Well, this is the end product of my legs from the recent fall is the one on the lower right and lower left after 1.5 month. The right scar is almost not visible to the eye. I have to admit i went lazy after 3 weeks and hence the left leg is really scarred.
Well i might not be a certified healthcare professional, but as a scientist i do try to provide most scientific and up to date information! Proper wound care is necessary to prevent infection, assure there are no other associated injuries, and to promote healing of the skin. An additional goal, if possible, is to have a good cosmetic result after the wound has completely healed.
Do refer to the references used for this post. Formspring me if you have more questions
Do refer to the references used for this post. Formspring me if you have more questions
Till next time~
Cheers,
I.
Reference list:
1. Ostomy Wound Management - http://www.o-wm.com/content/wound-cleansing-21st-century
2. Medscape - www.medscape.com/viewarticle/456300_3
3. Skin and Wound Treatment - http://www.ebnurse.org/index.php?id=31
4. Scar Healing - http://www.costhetics.com.au/news/scar-healing-with-silicone-gel/
5. Theory of Moist Wound Healing - http://www.clinimed.co.uk/Wound-Care/Education/Wound-Essentials/Theory-of-Moist-Wound-Healing.aspx
