Learn more about general wound care principles, and care of wounds associated with lymphedema.
Wound care has advanced significantly in the past 20 years, and there are more options for patients and generally better outcomes than in the past. We will first cover general wound care principles, and then address venous ulcerations and wounds associated with lymphedema.
Wounds are caused by trauma or breakdown of the skin and are considered “acute” if they are new. A wound is considered “chronic” if healing is not progressing normally after 3-4 weeks. In order for your wound to heal properly, the wound bed needs to be clean of dead tissue and infection, and have adequate blood flow. One of the modern principles of wound care is that moist wound beds heal better and quicker1.
General Principles of Wound Care
- Keep your wound clean. Cleanse and irrigate the wound with sterile saline unless otherwise instructed by your medical professional. Clean tap water may be substituted if saline not available. It is important to keep the wound bed clean. Irrigation of the wound with sterile saline can help remove bacteria. Use of other agents such as iodine or antiseptic solutions are generally unnecessary for routine wound care and could potentially delay wound healing.
- Keep the wound covered with a clean or sterile dressing. Choose dressings to keep wound bed moist, but that can contain drainage appropriately. Your therapist or physician can assist you with choosing the proper dressing.
- If your wound is worsening, see your medical professional promptly. If the wound is not making progress in healing after two weeks or is significant in size, see your medical professional for a full evaluation.
Debridement is the medical removal of dead, damaged, or infected tissue from the wound bed. Dead tissue can become a place for bacterial growth or can block the body’s attempt to heal the wound. Debridement, in different forms, is used in many cases to improve wound healing. Your medical professional should be the one who makes the decision about your wound care.
Selection of the appropriate wound dressing and changing it accordingly can have a big impact on how fast a wound heals, as well as scarring. No single dressing is perfect for all wounds, and often the type of dressing will change several times as wound healing progresses. It is best to work with an experienced clinician on a case-by-case basis. Basic types of wound dressings include:
- Hydrogels – can contain up to 90% water. These dressings add moisture to wound beds.
- Hydrocolloids – this is a sheet dressing that provides a moist healing environment and protects the wound from bacteria.
- Foam dressings – these can protect the wound bed and some are highly absorptive (especially foam dressings which contain Super Absorption Particles).
- Collagen dressings – these dressings contain collagen, the most abundant protein in the body and are often used on clean, granulated wounds.
- Silver dressings – silver is antimicrobial and can help reduce bacteria in the wound bed.
- Bacteria binding technologies to remove bacteria from the wound bed.
Signs of Wound Infection
All wounds have a certain amount of bacteria, but this does not mean the wound is infected. Normal healing can still occur. An infection occurs when the bacteria growth increases significantly. Call your doctor or nurse if you have signs of an infection. Classic signs of infection include:
- Increased Pain around the wound bed
- Redness or warmth
- Fever / chills or other flu-like symptoms
- Pus draining from the wound bed
- Increasing odor from wound
- Increased firmness of skin around wound bed or swelling around the wound bed
Chronic Venous Insufficiency and Ulceration
Chronic venous insufficiency, or CVI, refers to chronic venous disease in which there is limb swelling. Because the effects of elevated pressure in the veins can cause venous ulcers, compression therapy is the main therapy, along with good wound care. Venous ulcers require compression to the lower extremity to heal. They also are more likely to recur without compression. It is very important to follow your clinicians recommendations for compression.
To learn more about CVI, visit JOBST-USA.com.
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1. WINTER GD. Formation of the scab and the rate of epithelization of superficial wounds in the skin of the young domestic pig. Nature 1962; 193:293.