With the advancement in the medical and pharmaceutical industry and the increasing need to manage wounds out of hospitals, wound management has become the most complex than it has ever been. Wound management now focuses more on facilitating wound healing than just covering it. However, there are certain concepts about wound healing that have been passed through generations but experts advise against using them. With this, there is an increasing need to address those misconceptions associated with wound care that have no scientific reasoning. Dr.Kazu Suzuki who is Director of tower wound care center in Los Angeles got an article published in The Los Angeles Times where she cautions against the misconceptions regarding wound management in the following words.
“In the wound care world, don’t put anything in your wound that you wouldn’t put in your eye”
This article is going to discuss the myths about wound healing to show you a scientifically proven way to wounds management. Let’s start!
Common Wound Care Misconceptions You Shouldn’t Believe
The first thing to discuss here is what a wound actually is. A wound is a site for repair where various interlinked cellular processes are taking place consistently in a synthetic environment. Following are discussed a few myths that have been incorrectly linked to wound healing.
1. Clean wound with rubbing alcohol or hydrogen peroxide
This is a common misconception when it comes to wound management. As an antiseptic, alcohol or hydrogen peroxide may kill bacteria, but unfortunately, they do not make the best option for cleaning or disinfecting wounds as they also damage the surrounding healthy tissues. Not only it causes the skin to burn but is also unsuitable for sensitive wound tissues and for children’s wounds. Furthermore, studies suggest that these agents are locally toxic and have limited to no proven efficacy in promoting wound healing. (1)
Having said that alcohol does more harm to the wound than good, the next thing that must be coming to your mind would be what should be used for cleaning the wound. Experts recommend disinfecting it with antiseptic agents free of alcohol such as polyhexanide for painless wound cleaning. (2)
The best thing you can do for disinfecting the wound is to wash it with a plentiful quantity of soapy warm water immediately after the injury. Researchers find tap water fine for this.(3) Either take a warm shower or let the soapy water flow gently through the wound to flush the wound bed completely. In a hospital setting where patients come into the emergency room without irrigating their wounds, this must be done immediately before dressing.
2. Apply betadine every time the dressing is changed
Experts agree that applying povidone iodine is the worst thing you can do to a healing wound. Povidone iodine or iodopovidone is used as an antiseptic to disinfect the skin before and after surgery. The mechanism of its action is based upon betadine releasing iodine that kills the microorganisms at the site of the wound within 15 seconds. Betadine is mainly used for the disinfection and sterilization of unclean wounds. For dressing wounds, it is unnecessary to use betadine.
Furthermore, medical research has found that disinfectants including betadine are cytotoxic, which will damage the growth of granulation tissue and adversely affect wound healing. The varied studies provide evidence that betadine is not very effective in promoting good wound healing rather it impairs the healing process, causes infection, and reduces wound strength. (4)
That is the reason experts agree that betadine must not be used on healing wounds as it may cause skin irritation. Also, its use on large wounds may cause serious side effects like kidney problems, hypernatremia, and metabolic acidosis.
3. Apply antibiotic ointment to the wound
In the past, when injured, the elders of the older generation often applied tetracycline or erythromycin ointment to prevent bacterial infection. Scientifically, this would be referred to as antibiotic abuse. Experts recommend using antibiotics only for infections or when a wound takes too long to heal. Overuse or inadvertent use of antibiotics may lead to the development of resistant strains and hamper the body’s natural healing process. To investigate the effects of antibiotic ointment on wound care, a study was conducted to compare white petroleum ointments such as Vaseline with OTC antibiotic ointments like Neosporin. Results showed no noticeable difference in wound infection rate. (5)
4. The wound should be kept as dry as possible
Keeping your wound moist for better healing must be opposite to the common myth of keeping it completely dry. A major misconception is that lesions need to be “aired out” to let them scab quickly so there will be no "moist, easy to breed bacteria" situation. In fact, this could be the worst thing you can do to a wound. Wounds should not be kept dry as experts recommend keeping it moist for faster healing. Following are the benefits of providing a moist environment to the healing wound. (6)
· Prevention of cell death due to dehydration
· Accelerated development of new blood vessels
· Acceleration of growth factor’s interaction with their target cells and Increased breakdown of dead tissue and fibrin, i.e., precapillary fibrin cuffs
· Reduced pain in wounds covered with occlusive dressings
The above study has confirmed that wounds that are kept "moist" heal faster, but too dry will make the wound produce thick and hard scabs, which hinders the healing of epidermal hyperplasia. The bacteria and inflammatory tissue that got trapped in the scab may also cause infection.
Let us take the example of diabetic foot. Diabetes creates a hyperglycemic environment in the body, causing peripheral nerve paresthesia and sluggishness. Diabetics may experience wounds without knowing it; at the same time, neuropathy can also make the patient's skin dry and itchy. In the past, the concept of diabetic foot treatment was to keep the wound dry, but the new concept of wound care is to moderate the humidity. Compared with keeping the wound dry, properly keeping the wound in a moist environment can heal faster, providing a moist environment, absorbing excessive secretions, and reducing the chance of wound infection. Dr. Suzuki states that “keeping the wound moist throughout the healing process provides faster wound healing and minimal scarring”.
In the healing of ulcer wounds, moisturizing dressings can protect wounds, reduce the chance of infection, relieve pain, absorb exudate, remove necrotic tissue, promote granulation tissue formation, and reduce the number of dressing changes. similarly, keeping the wounds moist is found to accelerate re-epithelialization which reduces scarring, as compared to treatment in a dry environment. (7)
5 The wound should be exposed to air for faster healing
This is the misconception that has persisted for a long. Studies have shown that dressings that don’t allow the air to move in and out are associated with a lower infection rate. For this reason, occlusive dressings have been found to improve healing and reduce pain which improves the person’s quality of life as compared to gauze dressings. This keeps the wound clean, protected, and free of germs. That is the reason wounds need to be covered with dressing immediately after cleansing. The wound pad of the plasters acts as a cushion to protect it from painful friction and pressure.
Studies suggest that exposing the wounds to air causes them to lose their moisture which dries out the epidermis and results in scab formation. Occlusive dressings promote epidermal wound healing by preventing scab formation. (8)
What You Can Put on a Wound?
Let us now move to what you can put on the wound to let it heal faster. The first step in proper wound care is to clean the wound from the inside out, preferably with a large amount of sterile saline to reduce bacteria in the wound and to assess its condition.
If the wound is dirty, use 1% water-soluble beta-iodine to and wipe it from the inside to the outside, wait for 30 seconds to disinfect, and then wipe from the inside to the outside with normal saline. If there is an infected or inflamed wound, an appropriate antibiotic ointment should be used according to the instructions of a professional. The wound then must be covered with a suitable dressing properly.
Our bodies have amazing natural healing mechanisms if taken care of properly. All that is needed is to understand the healing mechanism and the myths related to it. It’s important to follow the best practice for wound care and avoid acting upon these myths Only professionals should be trusted when it comes to wound care as they know the nitty gritty of the procedure.