Thousands of people experience various types of wounds each day and it is vital to treat the wound appropriately using evidence-based information. Here we explore 7 myths of wound care relating to wounds, wound dressings and practice.
Table of contents
- 1.Wounds heal better when exposed to the air
- 2. If I bathe my wound in the ocean it helps it to heal
- 3. Iodine is bad for wound healing
- 4. If you have an local wound infection, antibiotics are needed.
- 5. Silver sulfadiazine is the best treatment for minor burns
- 6. Every wound with a black scab (eschar) should be moistened to help remove it and promote healing
- 7. Smoking does not delay wound healing
1.Wounds heal better when exposed to the air
If I had a dollar every time a patient asked me if they could take off their dressing as they think “it just needs to air”. This is one of the most common wound care myths I personally come across.
There is a belief that drying out the wound will help it to heal as nature intended.
http://wendykeithdesigns.co.uk/latest-news/natures-finest-article-on-wkd/ A dry wound bed will result in a lengthy healing process, impacting both the patient and the clinician, physically and financially.
I wish it was as easy as that, but “airing out” a wound not only slows wound healing but exposes people to an increased risk of infection.
There is a common misconception that applying moisture to the wound increases the risk of clinical infections. This is not the case, and it is presented in various research studies to show that moist wound healing has many benefits.
The fact is, moist wound healing encourages the wound healing process by:
- Preventing tissue dehydration
- Preventing cell death
- Increases the development of new blood vessels (angiogenesis)
- Encourages growth factors within the wound
- Reduced pain
- Less prolonged inflammation
The characteristics of moist wound healing includes:
- Maintaining a moist healing environment
- Is absorbent of excess exudate coming from the wound
- Fills any ‘dead space’ the space between the wound bed and the dressing itself
- Is warm and has insulating effects
- Protects against environmental microorganisms
- Does not cause harm
Although moist wound healing has shown by many studies to promote wound healing, there are particular times when moist wound healing should NOT be implemented. For example, in people with ischemic or neuro-ischemic wounds should be used with caution, and only used under http://activeimaginations.co.uk/wp-json/oembed/1.0/embed?url=https://activeimaginations.co.uk/2019/08/22/wild-walking/ strict medical supervision.
2. If I bathe my wound in the ocean it helps it to heal
This is another very common theme amongst patients who have wounds, that they want to help it to heal by bathing it on salt water at the beach.
In my practice, I have seen many wounds become infected after the patient has attended the beach to give the “wound a good soak”. There is a misconception that salt water will help it dry out and heal.
Not to mention the sand particles that can be found within the wound that has caused more harm than good.
Unfortunately, there are many microorganisms in water, not to mention the oceans and streams.
Normal saline that comes sterilized is the best to cleanse the wound with, it is clean and does not contain any microbes or particles that can settle in the wound. If you don’t have access to sterilised normal saline, boiled water is better than nothing to clean the wound.
3. Iodine is bad for wound healing
The use of iodine has been controversial in the wound care field, but it is still commonly used.
Iodine has been used in wound management for over 150 years.
Povidone iodine is different to cadeoxomer iodine.
Cadexomer iodine is a slow-release formation and has been proven to be effective in helping to heal chronic wounds. Depending on the amount of ooze coming from the wound, this product can be active on the wound bed for around 3 days, slowly releasing antimicrobial effects into the wound.
Povidone-iodine is broad spectrum and kills various bacterial, viral, protozoa and fungal microorganisms.
Povidone-iodine is an effective agent for use in infected acute and chronic wounds, to reduce hyper-granulation (healing that goes above the skin level) and great for keeping toes dry if there is a blood supply issue.
Iodine got a bad name for wound healing due to a number of studies, that when analyzed, were difficult to draw accurate conclusions from. These research studies have impacted on some health care professionals opinion on the use of iodine-based products in wound care.
There is now substantial evidence that shows low concentration iodine wound products that contain slow-release iodophors (Cadeoxomer iodine) improve wound healing times and an effective antimicrobial against many bacterial types. Slow-release iodophor antimicrobials are safe, effective and have little research to indicate toxic effects on the wound healing cells.
Povidone-iodine and Cadexomer-iodine products are very effective for acute and chronic wounds and will remain an effective treatment for the foreseeable future.
To date, there are no bacteria that are resistant to Povidone-iodine and Cadexomer-iodine.
Below is an example of available Povidone-iodine that comes on a swabs stick. Very handy to have in your first-aid kit! IT comes in a sterilized package and easy to open and apply.
4. If you have an local wound infection, antibiotics are needed.
When we break our protective skin layer, we are exposing our bodies to the vast world of environmental microorganisms. Many bugs that invade our wounds are often from our own skin flora. Talk about stabbing you in the back right?
There is a trajectory of wound bacterial colonization that occurs leading up to a very obvious wound infection. Some of the common signs of wound infection includes:
- increased pain
- An unusual odour coming from the wound (Malodour)
- Increase in ooze and/or a change in the ooze colour
- Increase in the size of the wound
cytotec no rx If you have any of these signs and symptoms of a wound infection, it is always best to see your Health Care Professional.
In saying that, there are subtle signs leading up to a wound infection that you can apply antimicrobials to kill off and reduce the bacterial load on the wound, preventing the infection from spreading.
Some of those subtle signs are:
- The wound changes in colour. Often from a bright healthy meat red colour, to a dull or even brownish colour.
- You notice a slight increase in the ooze coming from the wound
- You experience more pain than usual
- If the wound tissue changes in appearance and looks friable
- The wound may increase in size suddenly
What dressing types are affective against the early stages of infection?
- Silver impregnated wound care products. My personal favourites are aquacel AG and Mepilex Ag
- Iodine based products such as Iodosorb
Once these products are applied, they start killing off the bacteria within the wound bed and can prevent a more serious infection from occuring. So, to answer the question, not all wound infections require antibiotics.
If you catch the subtle signs of impending infection, catch it early to reduce the need to require antibiotics that kill not only the bacteria infecting your wound, but can reduce the important bacteria we need for optimal health such as gut bacteria.
5. Silver sulfadiazine is the best treatment for minor burns
The quick answer to this question is NO! Silver Sulfadiazine is not the best treatment of burns in this day and age.
In the past, the use of silver sulfadiazine was commonly used in the treatment minor to partial thickness burns.
As time has passed, the technology around dressing types has advanced to a point where silver sulfadizine is not necessarily the best choice in dressing product for minor burns.
The Australian Family Physicians recommends the application of a silver-based dressing that contains Nanocrystalline silver, as the first line of treatment for the first 48 hours. After this time, if there are any signs or symptoms of infection to continue with the Nanocrystalline silver dressings.
DermnetnZ agrees that nanocrystalline dressings are far superior to topical silver preparations such as silver sulfadiazine. Not only are these dressing superior in their reduction in infections, but have a lower overall cost and are less painful than using silver sulfadiazine.
6. Every wound with a black scab (eschar) should be moistened to help remove it and promote healing
In many cases, wounds with a black scab or eschar can benefit from moist wound healing. But the idea that every would should be moistened to promote healing following moist wound healing guidelines is a myth.
However, there are some cases that this is not recommended. This is especially the case if the person has a wound on their foot or toes, and their circulation is poor.
If moist wound healing is implemented in this case, it could be determinate and cause many life changing effects such as wet gangrene. If there is poor circulation suspected, further investigations are required and possibly referred to a vascular specialist to open up the arteries (revascularization)
To answer the question, not every wound with a black scab should be treated with moist wound healing techniques. It is always best to work with your regular health care professional to ensure the best management plan is put in place.
7. Smoking does not delay wound healing
Does smoking delay wound healing? Most certainly YES!
Cigarette smoke contains more than 4000 toxic chemical compounds, with many of those toxins known for impaired wound healing such as carbon monoxide and hydrogen cyanide.
Although this process and direct impact on wound healing is not well understood, here is a list of some of the known effects of smoking on wound healing:
- Smoking narrows blood vessels and reduces the amount of blood flowing to critical areas
- Carbon-monoxide from cigarettes enters the blood cells and reduces the amount of oxygen binding to those cells, therefore a reduction in oxygen to the wound bed
- People who smoke have a higher incident rate of wound complications as well as prolonged healing times
This is why surgeons request you to stop smoking at least 3 days before surgery, so the body can deplete carbon-monoxide in the blood and increase oxygen supply and increase the chance of a better recovery.