By Travis Layne, MPAS, PA-C and Tyler Sommer MPAS, PA-C, RMU Associate Program Director, Academic Director
Via RMUpload Podcast Episode 4
Physician Assistants provide much of the healthcare people receive today. As two of the faculty members of the Master of Physician Assistant Studies program at Rocky Mountain University of Health Professions (RMUoHP), we wanted to cover one of the more interesting and requested health related topics – wound care.
Wound care covers everything from rashes, scrapes, cuts, other wounds, and encompasses acute and chronic wounds. Acute wounds can include the ones we receive around the house like a cut or scrape and like those we may see in an emergency room, which are perhaps more severe but still should result in an acute situation. Acute wounds hopefully heal in under four to six weeks and may include stitches, dressings, or bandages.
Chronic wounds on the other hand, are wounds that do not heal properly and require the on-going care of a healthcare provider. These types of wounds require specialists and centers that will see you until it heals.
An example of an acute wound would be if you reach into a soapy sink of water and cut yourself on a kitchen knife, even if bleeding, the wound will probably heal in a few days to a week. Within two weeks the wound should be gone.
But if you have a wound around your ankle or on your foot, and you don’t know how it got there, you definitely should get in to get it checked to make sure it isn’t a chronic wound. Especially if it is getting bigger, oozing, or showing no signs of healing. Those types of wounds could be arterial ulcers, sometimes referred to as diabetic ulcers, that start on the foot with just a tiny scrape or sliver. You may not even know how it got there. It could also include swelling of the ankle or foot.
If an acute wound is not taken care of properly it can become a chronic wound. Especially if all the factors are not right – diabetes, alcoholism, malnutrition are some of the factors that can contribute. Chronic wounds can go back and forth, but never quite get to the healing phase. The risk in these cases include infections, they can become septic, lead to deeper tissue infections and possibly even amputation.
For proper healing, wounds need to go through a series of healing phases. The first thing in healing is coagulation, the bleeding needs to stop. Usually, the body is pretty good at stopping bleeding on its own. When bleeding, if you place a clean cloth over the wound with a little pressure it should stop bleeding in 5-10 minutes. If a wound is still bleeding 20-30 minutes later, seek medical attention since you could be losing blood and it could be more than a simple laceration or cut.
Best Dressing for a Wound
If a wound can’t close it has to heal from the bottom up. A closed wound, even with stitches, allows the skin to build up across the wound – a primary closure. This reduces the risk of infection and is the best way for a wound to heal.
- The most important thing to remember is getting that first initial point of closure healing, which happens in the first 48 hours.
- It will heal quicker and help skin cells do their job by keeping it clean, sterile, and with a bit of moisture with an antibiotic ointment.
- After 48 hours people can take off the bandage and to keep it clean and dry thereafter.
Diabetes and Chronic Wounds
Chronic wounds are not directly related to high levels of glucose in the blood stream, it’s related to the fact that the tiny blood vessels in the area of the wound need oxygen for the healing process. When the tiny vessels are so small and collapsed, they prevent oxygen and other necessary bodily to reach the wound for healing. The same situation is what also makes diabetics more susceptible to heart attack, only larger veins are involved.
The second wave of wound care is the inflammatory affect, which can compromise the immune system, increasing the possibility and likelihood of infection.
Diabetics who take care of monitoring their situation and watch and care for wounds should be fine. Proper care includes looking at the bottom of your feet each night and make sure there are no new sores, blemishes, or sores. If there are any, go to your medical provider to get them examined.
Do I Need Stitches?
There are some accepted principles in evaluating whether a wound should heal or if needs medical attention. They include:
- If you can easily spread a cut open or the edges don’t come together, that’s a laceration that should be looked at – it probably needs stitches.
- If it is deep to the point where you can see fat or yellow globs you probably need stitches.
- If it looks like it needs to be put back in where it came from, you need stitches.
- If the open wound looks yellow or like muscle or steak it probably needs stitches.
- If the wound is over a joint, there is a concern to tendons or ligaments that could possibly be cut or injured. In these situations, surgery may be needed to avoid a lack of functionality of the area.
Stitches can help a wound stop bleeding and provides primary closure so the healing process can begin.
Sometimes you need to look at the mechanism of the situation. If there is a very short injury or laceration, look at how it was caused. If it was caused by a knife and it’s about a centimeter long, it’s likely not deep and may not need medical attention. A serious wound that could require you should seek medical attention if it’s a stab wound, or you step on a nail/foreign object that is deep and/or breaks off in the wound.
Should I Use Hydrogen Peroxide?
In the past doctors would instruct patients with a cut lip requiring stitches to put hydrogen peroxide on the wound three times per day. Today, we don’t suggest people do that. Here’s why:
- Hydrogen peroxide does help fight off bacteria that could cause infection, but it has also been shown to slow the healing process.
- It can kill the bacterial cells, but it can also damage the skin cells needed for healing and covering the wound.
- The blood platelets in addition to helping stop the bleeding, are part of the signaling or healing process of the wound and hydrogen peroxide can prevent that.
Working in the operating room we instruct people on how to care for the wound. Usually we add sutures and cover it with a nice clean sterile bandage. We will also put an antibacterial ointment over the wound and instruct people to leave that on for the next 48 hours. No hydrogen peroxide.
Animal and Human Bites
Did you know that in a bar fight, if someone takes a swing and receives a wound by connecting with someone’s teeth, it is considered a bite? Bites, whether from animals or humans, should always receive medical attention. Mouths and teeth are breeding grounds for infectious bacteria.
- 80 percent of the time a cat bite is going to become infected. Most of the time we’re going to treat cat bites with antibiotics.
- 20 percent of the time a dog bite is going to become infected.
- If an animal bite has created a gaping wound, we often won’t close it with sutures all the way because of the high risk of infection.
- If we let it stay open a little bit, and if it does become infected, then the infection is able to drain out and be treated as necessary so the wound can heal by secondary closure intention.
- 15 percent of the time human bites become infected.
- Any bite that penetrates skin should be checked out.
Water to Help Prevent Infection
In a controlled environment, like in a sterile surgery environment where we have scrubbed, we have sterile garments on, and use sterile instruments, we still irrigate, irrigate, and irrigate liters of fluid on a wound to reduce the risk of infection.
You can apply the same concept to a bite or scrape on a leg. Once you’ve stopped the bleeding and applied pressure, the next best thing is to irrigate it as soon as possible.
- If you’re out hiking around and you fall and scrape your knee: Get your water bottle out and irrigate like crazy because that’s what will happen in the ER room.
- Studies show the most important thing we can do to prevent skin injury from becoming infected is to irrigate.
- In the past we used to make sure we were using sterile water, but studies show we can use tap or potable water to irrigate the laceration. It will have the same preventive care as in the ER. Even in the ER it could be just tap water and the results are the same for infection control.
Those interested in the Rocky Mountain University of Health Professions Physician Assistant program can visit our website or go to RM.edu for more information on applying and prerequisites of entry.
