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Wound Healing and Care
Different Types of Wounds
Most of us think of wounds happening because of accidents. But even clean surgical incisions are wounds. So are places where tubes or catheters go into the body. Anything that breaks the skin is a wound because when the skin is broken, there's a risk of germs getting into the body and causing an infection.
The deeper, larger, or dirtier a wound is, the more care it needs. That's why a team of doctors and specially trained wound care nurses work together to monitor and treat serious wounds.
Doctors and nurses start by evaluating a wound based on the risk of infection. "Clean" wounds — those that aren't contaminated with bacteria — have the lowest risk of infection, making them easier to care for. The incision a surgeon makes on a person's knee during ACL repair is likely to be a clean wound because it's a sterile cut in a place where there's a low risk of infection.
Dirty or infected wounds, like an abscess or gunshot wound, are a different story. They usually require special treatment and monitoring to prevent infection.
Sometimes a wound is clean but there's a risk of infection because of where it is on the body. If the wound is in an area that has more bacteria — like the urinary tract, gastrointestinal system, or respiratory system — fluids and other contaminants could get into the wound and cause infection.
Closing Serious Wounds
If a wound is clean, a doctor will close it by stitching the edges together in two separate layers. The doctor will use dissolvable stitches to join the deeper layer of tissue under the skin. Then he or she will staple, tape, or stitch the skin over it.
Sometimes doctors use dissolvable stitches or tape to join the upper layer of skin as well as the lower layer. Otherwise, the doctor will remove any surface stitches or staples after about 7 to 10 days.
Doctors don't always close a wound right away, though. If there's a chance a wound is contaminated, they will leave it open to clean it out. Closing a contaminated wound can trap bacteria inside and lead to infection. When they're sure there are no remaining bacteria or other contaminants, they will stitch or close the wound.
Sometimes, doctors decide it's best not to sew up a wound at all. If someone has lost a lot of tissue (like after a serious accident), it's often helpful to leave the wound open to heal through natural scar formation.
The Healing Process
Before healing begins, the body gears up to protect against infection. For the first few days, a wound may be swollen, red, and painful. This inflammation is the body's immune system kicking in to protect the wound from infection.
As the body does its healing work on the inside, a dry, temporary crust — a scab — forms over the wound on the outside. The scab's job is to protect the wound as the damaged skin heals underneath.
Under the scab's protective surface, new tissue forms. The body repairs damaged blood vessels and the skin makes collagen (a kind of tough, white protein fiber) to reconnect the broken tissue.
When the work of healing is done, the scab dries up and falls off, leaving behind the repaired skin and, often, a scar.
Why do scars look different from normal skin? Our skin is made up of two proteins: elastin, which gives skin its flexibility, and , which gives it strength. But because the body cannot create new elastin, scars are made entirely of collagen. So they're tougher and less flexible than the skin around them.
Caring for Serious Wounds at Home
Serious wounds don't heal overnight. It can take weeks for the body to build new tissue. So after you leave the hospital or doctor's office, good home care is important to prevent infection and minimize scarring.
Because wounds can be so different, your doctor will give you instructions on how to take care of yourself after you go home from the hospital. In most cases, doctors will ask patients to do the following things:
Our bodies rely on vitamins and minerals to heal. Try to eat healthy foods — especially lots of vitamin-rich fruits and vegetables and lean proteins — while your wound is healing. Drink plenty of water and eat high-fiber foods like whole grains to avoid constipation. (Constipation can be a side effect of pain medication.)
Your wound might heal quickly, but scars can take longer. For thick scars, try massaging the area with lotion or petroleum jelly. Doing this helps the collagen mingle with the elastin in the surrounding skin, decreasing some of the scarring. Ask your doctor or a wound care nurse if massaging the wound is a good idea before you try it.
When to Call a Doctor
If a deep or large wound gets infected, it can be a serious problem. Call your doctor or surgeon right away if any of these things happen:
There's good news about wound healing when you're a teen: Age is on your side because young bodies heal faster.
It may be frustrating having to hold back on activities like sports while a wound heals. But if you take good care of yourself and follow your doctor's advice, it won't be long before the wound is a distant memory.
Reviewed by: Tom Kopec, BSN, RN, WCC, WOCN