Put it on the wound

Proven content

There are wounds that are formed at an extremely fast pace, but they heal for weeks, even months, sparing the sick with pain and doubt. Treating them is difficult and expensive. These are the most important reasons why it is worth starting the appropriate therapy as soon as possible.

We divide wounds into acute and chronic wounds. The former arise after cuts or tissue cutting operations. They heal quickly (2-7 days) and, as long as they are properly cared for, are not a serious problem. On the other hand, chronic ones are those that do not close within a week or two, despite the observance of hygiene rules. In this situation, it becomes necessary not only to heal the wound, but above all to find the cause of this state of affairs. A wound that does not heal may indicate a serious disease in the body.

Chronic wounds affect the elderly much more often. There can be several reasons – worse tissue regeneration, inability to heal them, serious accompanying diseases, long-lasting diseases, e.g. poorly treated diabetes (persistently high blood sugar causes damage to the arteries, and this process ends with wounds or even amputation of the foot) or venous insufficiency, when wounds are a consequence of disorders of the nutrition of the tissues of the lower limbs. The longer we live with an untreated or poorly treated disease, the greater the risk that the skin will crack and the resulting increasingly larger wounds will not heal as a result of routine care activities.

When a doctor is needed

A wound that does not heal in at least two weeks should be alarming. Especially when additional symptoms appear, such as redness, swelling or pain, which indicate infection or inflammation. You must then immediately see a doctor to determine the cause. The sooner treatment is started, the greater the chance of faster healing.

Chronic wounds can arise for a variety of reasons. In terms of the frequency of occurrence, the following complications are ranked first: chronic venous insufficiency (approx. 80%), then diabetes mellitus (diabetic foot), pressure ulcers (the effect of staying lying down for a long time), complications of chronic arterial insufficiency, diseases of the lymphatic system, metabolic disorders , neuropathic, hematological, neoplastic wounds and postoperative complications (bacterial infections).

When observing disturbing symptoms, we should see a doctor who will direct the causal treatment. If the wound is caused by venous insufficiency, let’s go to a phlebologist or a vascular surgeon, when the reason is diabetes – to a diabetologist, in the case of bedsores – to a general surgeon. However, the most important thing is that he should have experience in the treatment of chronic wounds.

Error list

It is true that chronic wounds are difficult to heal, especially when they affect the elderly. However, healing problems are also often associated with non-compliance with the rules of conduct – improper selection of drugs or neglect of hygiene, which weakens the blood supply to the tissues around the wound, the wound itself renews itself, and even creates new ones. Very often, therapeutic management focuses solely on the wound, and not on removing its cause. And that’s a mistake! The wound must be healed – we nurture it, but we treat the main disease first and foremost.

One of the most common skin care and wound-healing errors is changing the dressing too often. And the rule is: change the dressing as often as necessary and as rarely as possible. In the case of chronic wounds, it should be once a week, and in the case of high exudate – every 2-3 days. Frequent change also irritates new, delicate tissues and destroys repair processes. For wound dressing, we recommend Aquacel Extra Ag + ConvaTec Silver Wound Dressing, which adequately protects the wound, maintaining an appropriate environment for its treatment.

It is a mistake to pour disinfecting fluids (eg Rivanol), hydrogen peroxide or preparations based on salicylic alcohol on the wound. Also, no antibiotics are used on the wound. In exceptional circumstances, an antibiotic is administered orally. The time required for the disinfectants and antibiotics mentioned to work is so long that they damage healthy cells and inhibit wound healing.

The safest environment for the wound is normal saline and preparations that protect against the access of pathogenic microorganisms and external infections, but do not damage the wound environment. The use of oiling preparations, e.g. petroleum jelly or zinc-based ointments, is also not a good decision. They are only used to protect the skin around the wound. We recommend Lecoxen – a set for wounds – spray and cream, or L-Mesitran Gel Soft Honey wound ointment, which accelerate healing and reduce the risk of complications.

TIME standards

The first letters of the English word TIME form a list of the most important rules for treating wounds. These are the generally accepted standards in the medical community:

• T (tissue) – the condition of the wound should be carefully inspected, and if necrotic tissues are present, remove them.

• I (infection) – pay attention to the condition of the wound – whether it gives the impression of being infected, whether there is purulent content in it, and the surrounding tissues are swollen. To find out about this, you can do a microbiological test, but for it to be of value, it must be done correctly, i.e. a biopsy should be taken from the wound and the material quickly delivered to the microbiological laboratory.

• M (moisture) – the wound needs a moist environment. This principle clearly distinguishes the modern approach to wound healing. Moisture is provided by the fluids produced by the wound. The nutrients and oxygen available thanks to the fluids guarantee proper granulation and the formation of the epidermis. No scab is formed and the wound heals without scarring. Pain ailments also decrease significantly. Excess fluid must be drained, which is what modern dressings are for. However, in order to use them, you must undergo training beforehand.

• E (edges – wound edges) – one should observe the process of skin formation on the edges of the wound, or if they are damaged by excess exudate.

But be careful! Applying the standard of wound care does not exempt one from causal treatment, depending on the disease the patient suffers from. In people with diabetes, metabolic disorders should be corrected, and the condition of the vessels responsible for the blood supply to the wound should be taken care of. In the case of lower limb atherosclerosis, it is sometimes necessary to perform an operation to unblock them (arterial bypass) in the area of ​​arterial vessels in the legs. Venous insufficiency can be reduced or eliminated by removing ineffective superficial veins. In other cases, treatment with pressure (so-called compression therapy) is necessary for the rest of your life. Correct positioning of a person with pressure ulcers, frequent changes of position and stimulation of circulation by massage or lymphatic drainage helps to avoid chronic pressure on the tissue.

Let’s also not forget that prevention is much cheaper than treatment. In the case of a diabetic foot, it is important to control blood sugar levels, take medications and regularly hygiene the foot. In venous insufficiency, it is important to treat varicose veins early and to lead an active lifestyle.

The ABC of Chronic Wound Care

1. Carry out diagnostics to determine the cause of wound formation and start intensive treatment under the supervision of a specialist doctor.

2. Wash the wounds with 0,9% saline solution or Ringer’s solution. We should be careful with special preparations for disinfecting wounds (eg Octenisept). We should also not use disinfectants – spirit, iodine or hydrogen peroxide, because they destroy the newly formed, very delicate epidermis and granulation tissue, i.e. the newly formed tissue.

3. Avoid frequent and excessive use of ointments, creams and gels on the wound without consulting a doctor.

4. Let’s clean the wound of dead tissue. The doctor should decide how to remove them during the consultation. Several minutes of surgery or ultrasound may be necessary. Often it is enough to use special prescription enzyme preparations.

5. Keep the wound in a moist environment thanks to modern, specialized dressings. They do not stick to the wound surface, so changing them does not damage the tissues and does not cause pain.

6. We care for the skin around the wound with slightly acidic preparations, which inhibits the growth of harmful bacteria.

7. The wound should not come into contact with clothing and the dressing must be applied to prevent contamination.

8. Depending on the healing stage, the doctor prescribes the frequency of dressing changes, aiming to change the dressing once a week.

Several hundred different types of preparations are registered in Poland. They can be divided into the following types:

• hydrogels (e.g. Intrasitegel, Aquagel) – have the ability to absorb exudate, maintain high humidity, allow for cell proliferation and healing, also have cleansing properties, hydration of necrotic tissue, order Microdacyn 60 – hydrogel for disinfection and treatment of wounds or Hydrogel for wounds GranuSept, which not only moisturize, but also cleanse wounds, accelerating their healing;

• hydrocolloids (eg Granuflex, Tegasorb) in the form of platelets with layers, which form a gel in contact with the wound exudate, under which the granulation process takes place;

• dextromers (eg Acudex, Debrisan) – dressings made of polysaccharide grains, which form a gel upon contact with wound exudate; used to treat large, deep and infected pressure ulcers;

• alginine dressings (eg Kaltrostat, Tegagel) – dressings made of natural polysaccharides obtained from sea algae with very high absorbing properties; at Medonet Market you can buy Suprasorb A calcium alginate fiber dressing;

• semi-permeable polyurethane membranes (eg Opsite, Tegaderm) – allow for the free evaporation of exudate from the wound surface, but are impermeable to water and bacteria from the outside. Try the Suprasorb P sensitive border lite silicone foam dressing.

At Medonet Market you can also buy Farmactive Silver – a wound spray with colloidal silver and hyaluronic acid. Before applying the dressing, it is necessary to properly clean and disinfect the wound. For example, Microdacyn Wound Care – a preparation for disinfecting wounds, will work well here.

Naturally therapists, for a change, recommend the use of New Zealand Manuka honey in the case of, among others, bacterial infections, healing skin ulcers or difficult to heal wounds. However, it is difficult for doctors to comment on this. Natural methods are not excluded, but must be controlled. Similarly, there are no unambiguous opinions about the beneficial effects of ozone therapy (a procedure consisting in administering ozone to an open wound, additionally in the form of a drip along with an antibiotic).

For difficult-to-heal wounds, it is worth using verbena infusion compresses.

Consultation: medical team of doctors of the Phlebology Center, Warsaw, ul. Witoszyńskiego 5, tel. (0 22) 613 62 56