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Special Features

What You Need to Know About Wound Management

By: Marthony Basco, MD article_9

Christopher was playing outdoors when he accidentally stumbled and wounded his knee. Reaching home, he immediately washed his skin with water and soap. There was some pain but Christopher bit his lip so as not to alarm his mother. During lunch, his mother noticed that there was something funny in the way he walked and she noticed the fresh wound on his knee. His mother prepared some cotton and alcohol (which was even more painful), painted his wound with orange Mercurochrome, opened an antibiotic capsule, and placed the powder on his open skin.

Quite the usual wound management at home? Well, let’s see what actually works and what should be avoided.

  1. The skin and its functions – The skin is the largest organ of the body, making up 16% of body weight. Some of its vital functions include immune function, temperature regulation, sensation, and vitamin production. The skin is constantly changing as the cells of its outer layer shed repeatedly and get replaced by inner cells moving to the surface.
  1. Wounds and normal healing – Wound repair is one of the most complex biological processes in humans, occurring throughout an orchestrated cascade of overlapping biochemical and cellular events. Traditional therapies and natural products have been used, with promising results, to stimulate the regeneration process and prevent healing failure.

Although these products are, in general, less expensive than modern treatments, they can be sensitive to the geographic location and season and exhibit batch-to-batch variation, which can lead to unexpected allergic reactions, side effects, and contradictory clinical results. But because such practices have been passed on for generations, without really asking how or why these ‘concoctions’ take effect, it has been quite difficult to change the mindset of both adults and children alike.

  1. Traditional Wound Management
  1. Water – Irrigation is still the best method for the initial management of wounds. Running water takes off dirt and other impurities that get trapped in your open skin. Oftentimes, warm to lukewarm water may be less painful while the increased temperature may even stimulate blood circulation for faster wound healing. Avoid using too much-pressurized water (from a hose or bidet) that may damage much tissue especially if the skin has a wide opening.
  1. Soap – Ordinary soap is enough to kill some harmful bacteria, but be sure to wash off excess soap that may irritate surrounding cells and tissues. Avoid strong detergents and compounds like dishwashing liquids which are too strong and may cause irritation and chemical reactions.
  1. Alcohol and Hydrogen Peroxide ­­– These two compounds are very popular in sterilizing and cleaning open wounds, but there are conflicting pieces of evidence regarding their use in wound healing and treatment. When used on intact skin, alcohol and hydrogen peroxide are good sterilizing compounds that can kill potential bacteria and viruses. When used on open wounds, alcohol is extremely painful and may slow down wound healing. Hydrogen peroxide, the solution that causes bubbles on open wounds, may not be that painful but the reaction it causes on open skin may result in potential harm to cells and surrounding tissues.
  1. Mercury-containing compounds – The reddish-pink tincture of mercury-containing compounds was popularly used for wound treatment. Mercurochrome (generic name: merbromin) is a compound of mercury and bromine while Merthiolate (generic name: thimerosal) is a compound of mercury and sodium. These compounds kill some disease-causing microbes by altering enzymes and other proteins and breaking up the chemical bonds in proteins so that the metabolism of the microbes is blocked. Both are also widely used as topical antiseptics that are applied to the surface of the skin.

Up to this day, Merthiolate is used to help rid skin of bacteria prior to medical procedures. Along with iodine preparations, both compounds sting when applied to broken skin and can interfere with healing. Experts now suggest to include newer antibacterial creams in first aid kits, particularly those with bacitracins. They come from a class of antibacterials which was produced first by other microorganisms.

  1. The powder inside antibiotic capsules – It used to be that every home had a medicine cabinet that served as first-aid kit; more often than not a capsule or tablet of penicillin can be found. The tablet would be crushed into powder form or the capsule is split and the powder is spread on wound sites to serve as partial covering and antibiotic. This practice is NEVER advised or recommended because tablet and capsule preparations are designed to be swallowed and not for topical use. Popular and effective antibiotic creams, lotions, and ointments are available, however, be cautious in using topical antibiotic compounds since misuse or overuse may result in antibiotic resistance that may promote wound complications.
  1. Herbal concoctions – In Philippine tradition and culture, the herbalist (‘herbolaryo’) is highly sought after for treatment of ailments and illnesses. Often called alternative or traditional medicine, the Department of Health has conducted studies and researches, coming up with a list of recommended plants with medicinal benefits for wound management.
  • Akapulko (Cassia alata) – This herbal medicine, also called ringworm bush or shrub and acapulco in English, is used to treat tinea infections (such as an-an), insect bites, ringworms (buni), eczema, scabies (galis aso), and itchiness.
  • Ampalaya (Momordica charantia) – commonly known as bitter melon or bitter gourd in English, has been found effective in the treatment of diabetes mellitus, hemorrhoids, coughs, and burns and scalds. It is currently being studied for anti-cancer properties.
  • Bawang (Allium sativum) – or garlic in English, has antibacterial, anti-inflammatory, anti-cancer, and anti-hypertensive properties that treat infections. It is also widely used to reduce cholesterol levels in the blood.
  • Bayabas (Psidium guajava) –  or guava in English, has plenty of healing properties used in folkloric medicine. Guava is an antiseptic, anti-inflammatory, antioxidant hepatoprotective, anti-allergy, and antimicrobial solution among other characteristics.
  • Sambong (Blumea balsamifera) – This herbal medicine, whose English name is Ngai or Blumea camphor, is used to treat kidney stones, wounds and cuts, rheumatism, colds and coughs, and hypertension. It also has anti-diarrhea and anti-spasm properties.
  • Tsaang Gubat (Ehretia microphylla Lam.) – A herbal medicine called wild tea in English, is taken in as a treatment to skin allergies along with eczema, scabies, itchiness, and wounds in childbirth.  

To cover or not?

You may have heard that letting a wound heal in dry air is the best way, but medical research shows that the opposite is true. A moist wound condition will not only speed up the healing process but also prevent scarring and scabs.

Signs that your wound is going bad:

Wound infection may be defined as the presence of bacteria or other organisms, which lead to a host reaction. A host reaction can exhibit one or a combination of the following local and systemic clinical indicators:

Local indicators

  • Redness (erythema or cellulitis) around the wound
  • Increased amounts of exudate (any fluid that has exuded out of a tissue or its capillaries because of injury or inflammation)
  • Change in exudate’s color
  • Malodour
  • Localized pain
  • Localized heat
  • Delayed or abnormal healing
  • Wound breakdown

Systemic indicators

  • Increased systemic temperature
  • General malaise
  • Increased leucocyte count
  • Lymphangitis (painful lymph nodes near the wound site)

Common traditions and practices may not always have a scientific basis; some find it irrational or even harmful. Thus, the importance of seeking the correct information and being inquisitive in the traditional and common practices on wound care may promote healing and prevent infections and complications. If symptoms persist, it is always good to consult your friendly and accommodating doctors.


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Keywords: lymphangitis, malodour, erythema, wound infection, wild tea, sambong, guava, garlic, bitter gourd, acapulco, herbal medicine, antibiotic, bacitracin, thimerosal, merthiolate, merbromin, open wounds, hydrogen peroxide, alcohol, soap, irrigation, water, wound repair, skin, mercurochrome, wound management   
  
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