Understanding the Basics of Home Wound Care

There’s nothing like a cut or a healing wound to really interfere with your day—especially if you don’t care for it properly as it heals. Caring for wounds may seem straightforward to the average person, but medical professionals know the truth is often very different: if the wound is serious enough, it almost always requires an individualized treatment plan.

Every patient is different; some may heal faster or slower than others while others may have chronic health conditions that impact the ability to heal at all. Whatever your situation, understanding the basics of home wound care will empower you to treat your wound and identify complications in a much more efficient and suitable manner.

What is a Wound?

This may seem like an oversimplification—after all, most patients understand that a wound is an “injury to living tissue,” usually the exterior body itself. That doesn’t tell us much about what a wound really is at a biological level.

Let’s look at what causes wounds:

• Impact trauma
• Chemical burns
• Temperature burns
• Immunodeficiency disorders
• Insect bites and/or stings
• Animal bites or scratches
• Pressure (e.g. bedsores)
• Malignant cancers
• Connective tissue disorders
• Diabetes and other endocrine disorders
• Self-injury and/or self-harm
• Certain medications (e.g. immunosuppressants)

This is far from an exhaustive list, but it does cover a few of the most common reasons for wounds.

The human body is built to heal itself; that’s why your immune system exists in the first place. The moment you cut or injure yourself, it creates an entry point to your bloodstream and internal organs. Any time you have an entry point, you have an increased risk for pathogens to enter the body and cause infection. Your immune system identifies wounds as a potential threat and immediately works to close the wound off and heal it to seal out pathogens. That process occurs in several individual steps.

Hemostasis

This is the first (and perhaps most important) step in the body’s natural ability to heal. Hemostasis might sound like a complex word but it simply refers to blood clotting. When you experience a cut or wound that breaks the skin, it will begin to bleed. This process isn’t just a side effect of the wound; it can also flush out debris and bacteria, too.

As soon as your immune system detects the intrusion—often seconds later—it will send out white blood cells and clotting factor (a chemical within the blood that causes blood to clot) to the area. The infusion of chemicals should create a blood clot at the area, sealing it off from the outside world.

Important: A few seconds of bleeding is just fine; heavy or unstoppable wound bleeding or blood or spurting blood can indicate a bleeding disorder, arterial involvement, or the need for stitches. If you experience these symptoms, don’t try to self-treat. Call 911 for spurting or heavy bleeding. Visit your emergency room immediately for bleeding that refuses to stop within 10 minutes.

Inflammation

The next step in the natural healing process is inflammation. This is what you see when the area around a wound becomes slightly swollen or reddish in appearance; the body is rushing extra blood loaded with white blood cells, neutrophils, and plasma to the area. These chemicals work in tandem with macrophages and cytokines to tidy up the wound and create new tissue.

Fatally injured tissue dies off and is digested or absorbed into the body, while neutrophils digest any bacteria and release enzymes that increase new cellular activity. Cytokines bind to new cells, telling them to either move to another location or to replicate and grow. This is where new tissue comes from. Macrophages simply provide an extra layer of protection against bacteria.

The end result is the replication of new tissue to replace what was lost in the wound. This is why not all inflammation is necessarily indicative of infection even if it increases pain or warmth around the wound.

Important: Some inflammation is normal; excessive swelling, weeping of greenish pus, extreme warmth with intense pain and/or red streaks traveling away from the wound are not. This usually identifies an infection; seek advice from your doctor if you exhibit these symptoms.

Proliferation and Remodeling

These two stages often overlap and occur for the longest period of time. Proliferation itself can take as long as three weeks or more; this is when cells continue to divide rapidly and move around, reforming the area and using a substance called fibrin to create a framework for new tissue within it.

Remodeling strengthens the new tissue framework and “fills it in” continuously.

The latter can take up to two years depending on the severity of the wound; this is why some patients seem to experience a recurrence midway through the healing process. It’s also why it is so important to treat the area with proper home wound care until it’s fully healed.

If all goes well, you exit this state with new, healed tissue (and maybe a small scar).

Wound Types

Now that you understand exactly what’s happening inside your wound, you can begin to care for it appropriately. The first step of home wound care is to identify the severity and healability; your physician will usually assess this if it is severe enough. Wounds fall into three categories:

• Healable – A healable wound is any wound that is expected to eventually heal completely with the right home wound care
• Chronic – Chronic wounds may or may not eventually heal; their main definition is that the healing process is difficult and prone to repeated failures along the way
• Non-healable – Non-healable wounds always require medical attention regardless of the severity, as the usual approach is to remove or debride the tissue to prevent necrosis (tissue death) or gangrene

Chronic wounds are very common in certain populations. Diabetic and immunodeficiency ulcers fall under this category. The patient’s own immune system seems to lack the ability to repair these injuries, and they may require a high level of treatment for long-term maintenance or repair instead.

Non-healable wounds are more serious; most are either healable or chronic wounds that for some reason begin to degrade, resulting in gangrene or tissue death. This can be due to infection, immune system problems, or even poor circulation.

Home Wound Care Steps

To begin caring for your wound at home, first identify the type of wound and the severity of the damage. You can treat most minor healable wounds at home using the following steps.

1. Clean

If you cut yourself or otherwise create a break in the skin, begin care by rinsing the wound under clean, room-temperature water. If there is bleeding, cool or cold water may help it to clot off more quickly while reducing pain. Do not use harsh soaps, chemicals, or antibacterial soaps in a wound; these are harsh and may damage sensitive tissues.

If you are concerned about infection, a saline wound rinse is ideal. Be cautious with hydrogen peroxide; while it is effective in an emergency, it can also kill healthy tissue, too, and that can hold back healing.

2. Pressure

For bleeding that doesn’t stop in the first few seconds, use gauze to apply pressure directly onto the wound. If it bleeds through, add more gauze. Leave the lowest layers in place for at least 10 minutes. Raising the wound above the heart may help. Note that free bleeding is much more of an issue than very slow seeping; some wounds may continue to seep a few drops of blood for 24 hours or more. This isn’t necessarily a problem.

3. Coat and Cover

Once the bleeding stops, apply antibacterial salve or cream in a thin coat over the wound. Some preparations contain numbing agents that may reduce pain; these are fine to use sparingly. Cover the wound in a bandage or several layers of gauze. Change it daily or whenever blood and fluids soak through it.

Special Situations

There are certain situations where you should not attempt home wound care; a few of of these (like excessive bleeding and signs of infection) have already been mentioned above. Diabetics, anyone with an immunodeficiency disorder, and people with wounds that fall under the following categories should always visit the doctor first, too. If the wound:

• Gapes or refuse to close
• Is larger than 1” in length
• Appears shredded or uneven
• Is embedded with debris
• Occurs as a result of rusty metal
• Occurs after an animal bite

Rinse the wound, cover it with gauze, and then visit your nearest emergency department.

Proper home wound care is such a critical part of healing that it pays to monitor wounds and attend to them regularly even if they aren’t serious. If you have any questions about your wound, or you are experiencing other symptoms that make you unsure of the proper treatment method, call your local pharmacy. Your pharmacist can help you to triage the situation and will make a recommendation for future care.