Wound Care and Healing
WOUND CARE AND WOUND HEALING
WOUND TYPES:
The normal anatomical structure of the tissue is called "wound". Wounds can be caused by various reasons.
1-Acute surgical wounds: During the surgery with a sharp cutting tool is a smooth incision. They usually show a systematic and regular recovery.
2-Trauma-related wounds: Depending on the type of trauma can be simple and complicated, tissue deficiencies that can cause long-term medical and surgical treatment is required.
3-Burn wounds: Hot-flame, friction, electricity, cold, radiation and chemicals due to different degrees of burn wounds may develop. Treatments may continue for long periods.
4-Chronic wounds
5-Pressure sores
6-Infected wounds
APPROACH TO CUT:
1-Examination: Large and small skin incisions are frequently encountered especially in children. Before starting the treatment of these incisions, the patient should undergo a complete physical examination for trauma and radiological examinations if necessary. Possible head trauma, intra-abdominal organ injury, body injury… should not be overlooked. In the examination of the incision, tendon-muscle, nerve, vascular incisions, contamination and foreign bodies in the wound and possible bone fractures should be thoroughly examined.
2-Anesthesia: Local and general anesthesia methods can be applied. General anesthesia may be preferred in children and infants where cooperation is difficult and complicated procedures are required.
3-Wound cleaning: Wounds are treated with antiseptic solution and foreign substances are removed. The wound can be cleaned by means of brushing and the use of pressurized water. Infected wounds, debridement and removal of dead tissues can be performed, and in some cases wound closure can be delayed.
4-Wound closure:
- In very small incisions and friction wounds, the wound can only be closed by dressing.
- Tissue adhesive: Skin tissue adhesive can be used for cuts that are superficial, free of bleeding, clean, small and without wound tension. Tissue adhesive should not be used inside the wound. Because glue, which is not absorbed by the body, can cause reaction and cause infection and excess scarring.
-Steristrip: Clean, superficial, non-bleeding wounds, close to the wound edges and Steristrip can be used. Steristrips can also be used as a support after suturing. Steristrip alone on the edges of the stretched and deep wound is not successful. May cause a wound.
- Suture closure: Different sewing materials and wires can be used according to the body area and depth of the incision. In deep incisions, subcutaneous sutures may also be necessary. In fact, the term dikiş aesthetic stitching, laser stitching ’is not realistic. A different sewing technique can be used in each region. What is important is to use the finest stitches possible and to obtain the stitches as early as possible after adequate tissue healing, using gentle techniques to ensure the lowest possible tissue tension without damaging the tissue. In infants and in some body areas (oral, vagina…), self-melting sutures can be used. Sometimes subcutaneous stitches that are not visible from the outside can be used.
5- Dressing:
Different dressings can be applied depending on the location and condition of the incision. water contact is usually prevented in the wound for 48-72 hours. Clean wound; If not covered with steristrip, follow 1-2 weeks with oily creams and ointments is useful for skin epithelialization. Cream and ointment is not preferred for leaking or dirty wounds; Desiccant dressings are recommended.
In clean incisions, steristrips can be used until suture is removed or even after removal. Steritrips should not be withdrawn when they are taken, they should be easily removed after wetting and softening.
6-Antibiotic therapy and tetanus prophylaxis:
Antibiotics are not used for clean incisions. Recommended for dirty incisions. Tetanus prophylaxis may be required.
7-Sewing (suture) taken:
Melting stitches may not need to be removed. Embedded stitches are not removed. Stitches in areas such as eyelids take 3-5 days, while the fingers may take up to 15 days. Factors such as wound tension and healing status should be considered.
8-Follow-up and suggestions:
After suture removal, it gained 10% of wound strength. Therefore, it is better to protect the wound area for 1 month. It should be noted that wound healing continues after the sutures have been removed. In order to prevent bad scar formation, steroid pomades can be applied to the incision site by massaging for 6-18 months. In some cases, steroid injection, compression garment, silicon gel sheet may be recommended. It is very important to protect the wound area from sunlight for 2 years.
WAYS TO REDUCE SURGERY TRACES
1- Suitable surgical technique:
- It should be remembered that the stitching technique called aesthetic stitching is not traceless and may sometimes leave more marks than other stitches. The recommendations of a specialist should be carefully listened to.
- Surgical incisions during surgery should be placed on the body lines, if possible, in parallel and in areas that are easier to camouflage in the body (such as in the nose esthetics in the nose, in underwear in abdominal stretching surgery).
-The suture materials remaining in the skin during suture closure of the surgical incision should be preferred from those who react least and the tension between the wound lips should be reduced.
- During skin stitching, use the smallest possible suture material that can support the skin tension firmly, and if the body does not melt sutures, sutures should be taken as early as possible. The stitches taken too early may cause wound opening; may cause worse healing and more scars.
-The stitches should be folded to reduce surface tension. Excessive sutures may impair blood circulation, resulting in scarring and scarring; excessive sewing should be avoided.
- Steristrip tapes can be used in non-inflamed and non-discharge sutures to reduce tension on skin. Steristrip alone or after suturing is not successful in the leaky, moist, easily wetted and sweaty areas and the bands are removed.
- In some incisions, the use of glue may cause more reactions and scars than stitches. Tissue adhesives should not be preferred except for very superficial cuts.
2-Proper wound care and dressing:
- Considering factors such as location, condition and width of the wound, it should not be soaked and washed for 48-72 hours after suturing. The healing of the top layer of the skin is completed in this period.
- In some dirty and discharge wounds, it may be necessary to wash with plenty of water, pressurized water or soapy water. In such wounds, early stitches are not removed. In open wounds, either self-closure or subsequent surgical closure is planned. Follow your doctor's dressing recommendations.
- Stress-increasing movements should be avoided at the operation site (doing sports, lifting weights, coughing in patients with abdominal wounds, constipation kalmak)
- To the extent specified by your doctor, rest and partial movement prohibitions must be observed.
- Blood sugar levels should be controlled more carefully in people with disrupting wound healing such as diabetes.
- In some inflamed or risky incisions, antibiotic treatment is given upon the advice of your doctor. Unnecessary antibiotic use should be avoided in clean and simple wounds.
-Clean and dry incision places suitable creams and ointments are used minimally, the incision area is provided to be minimal moist.
-Batikon-like dressings containing iodine will delay wound healing and should not be used.
- Incision areas should be kept clean and dry. Creams and pomades, if used in abundance and in a way that the body cannot absorb, can form a mud-like layer on the wound. This can lead to infection. These substances should not be used unconsciously and without the advice of a specialist.
-Alcohol and peroxide-like products should not be used at incision sites. They irritate the skin and disrupt healing.
- Dressings should be continued depending on the condition of the wound.
- Trace reduction creams according to the top layer healing of incision 3.-4. It can be used between 6 months and 2 years. The drug activity is the best known pomade Kenacort.
- Sun protection creams should be used for incisions in areas exposed to the sun. Recommended for up to 2 years.
- More frequent follow-up and different treatment options such as pressure gauze, silicone gel sheet, Kenacort injection should always be considered in people who have previously healed scars with hypertrophic scarring or keloid-like fluffy healings.
- Start skin massage when and when your doctor sees fit.
NUTRITION:
-Smoking disrupts wound healing. No smoking is ideal.
-Alcohol and caffeinated drinks should be avoided.
Vitamin C, protein diets accelerate wound healing.
-The body should not be left without water. You can decide for yourself how much water you should drink daily from your urine color. A dark urine output indicates that you are dehydrated. Drink water to maintain a colorless or very light urine output.
FACTORS THAT CANNOT BE CONTROLLED ON SURGERY:
1-Age: As we get older, our skin becomes less elastic and thinner. Many factors, such as smoking the sun, are also involved. Therefore, as you age, healing becomes more difficult. But for people with more wrinkles and wrinkles on their skin, the camouflage of the scars becomes easier. Wound tension is less.
2-Skin color, race: The risk of bad marks on the skin is greater in the black race. On the other hand, even the slightest trace of light colored ones may be more noticeable.
3-Genetic factors: Some people may have a bad healing problem in the family. However, it does not mean that the same problem will certainly occur in people who have poor wound healing in their family, nor does it mean that the same problem will certainly occur in children of those who have poor wound healing in themselves. It is not possible to predict this in advance.
4-Depth and width of the incision: Deeper, wider and fragmented, more dirty, more stretched wounds are more at risk of scarring.
5-Wound healing rate: Some people are born lucky in terms of rapid and trackless wound healing.
6-Operation site: Although there is a greater risk of scarring on the back of the hand, this risk is lower in the palm. Such areas such as earlobe, chin tip, shoulder, mid-rib cage are more risky in terms of scarring.
33AXX
Spenco 2nd Skin Squares Soothing Protection for Blisters, Hot Spots and Skin Irritations, Gel Squares 200-Count
