Link - Good Health Pharmacy

A wound is any break in the outer or deeper layers of the skin and soft tissues of the body, which may result in bleeding and may allow potentially infectious microorganisms to enter the body.

Wound contamination is normal in most wounds but minor, contaminated wounds usually heal without the need for antibiotic therapy. Most minor wounds heal well, leave little or no scarring and do not require medical attention. More severe wounds and infected wounds, on the other hand, may require appropriate medical intervention by your Link clinic sister, your Link pharmacist or your GP.

Basic classification of wounds

A wound can either be classified as an open or a closed wound.

Open wounds

There is a break in the outer layer of the skin. This type of wound may result in bleeding and may lead to infection due to the fact that open wounds may permit the entry of germs. Acute open wounds include: abrasions, burns, lacerations, and cuts or punctures that are localized to the site of the injury. Chronic open wounds include ulcers or pressure sores.

Closed wounds

There is usually no break in the outer layer of the skin and no external bleeding. Sometimes in this type of wound there may be internal bleeding which may be severe but the risk of infection is low.

Causes of wounds

There are many causes of wounds:

• Acute trauma or injury.
• Immobility in an elderly or bed-ridden patient, which may lead to poor circulation and result in pressure sores and impaired wound healing.
• Surgical incisions.

Barriers in wound healing

Factors that may delay wound healing include:

• Cigarette smoking
• Medications such as corticosteroids and other immunosuppressants
• The presence of infections
• Age, particularly the very elderly as they often have poor blood circulation
• Inadequate nutrition - vitamin A, vitamin C, Zinc and protein are required in wound healing and lack of these nutrients may often result in a delay in wound healing
• Underlying medical conditions such as diabetes mellitus
• Exposure to air – the modern approach is to cover the wound as this has been shown to enhance wound healing

STEP-BY-STEP WOUND MANAGEMENT

The goals of appropriate wound care are to keep the wound moist, clean and free from infection. You should seek professional advice for more serious wounds, but these are the basic guidelines when dealing with a wound:

1. Stop the bleeding by applying direct pressure (If the wound continues to bleed after applying direct pressure for 10 minutes, seek further medical attention.

2. Wash the wound area with water or saline. Minor abrasions and scrapes usually only require cleansing of the area with water or saline. A mild antiseptic soap may be used. However, soaps can often irritate the wound so you should avoid using harsh soaps.

3. Remove foreign particles in the wound e.g. glass, grass or dirt as these may be sources of infection. DO NOT try to remove any large penetrating objects which have become deeply embedded in the soft tissues. Seek medical attention immediately.

4. After cleansing, gently pat the wound dry with some sterile gauze.

5. Get medical attention for a gaping wound that may require stitches. It is important that such wounds are evaluated within six hours of injury, as a delay may mean that the wound cannot be sutured due to infection.

6. Cover the wound with an appropriate dressing. A semi-occlusive dressing is a well-established method of dealing with most wounds. It prevents the wound from drying out and bacteria from penetrating but allows ‘breathing’. Some dressings may only need to be changed once a week. If a clear dressing is used, this allows inspection of the wound without the need to change the dressing (which could reopen the wound again). An antiseptic dressing may be used to help prevent infection in cuts, grazes, scalds and minor burns. It is applied directly to the wound i.e. as the primary dressing and is then secured in place with another or ‘secondary’ dressing. Alternatively, a topical antiseptic ointment may be applied before covering the wound with an adhesive dressing. Never apply cotton wool to a raw wound as the fibres will become embedded in the scab and removal will be very painful. the dressing should also not be too tight as this could interfere with the blood supply.

7. See a doctor or your Link pharmacist for more severe wounds and infected wounds which may require a topical antibiotic or a systemic antibiotic if infection has spread to the surrounding tissues.

Treatment of associated symptoms

For pain associated with wounds, a simple analgesic e.g. paracetamol or a non-steroidal anti-inflammatory drug e.g. ibuprofen may be recommended.

Talk to your Link pharmacist for further advice on dressings and medication for pain.

By Moshibudi Marishane, Tsepiso Makua and Sibusiso Kubheka, B. Pharm III, University of the Witwatersrand.
References available on request