Wound Care Services
In the phase of inflammation, local treatment is carried out: bandages are made daily using the full range of mechanical, physical, chemical methods of antiseptics. With indications (abundant exudation), more frequent bandages are performed. The damaged area is immobilized, detoxification and antibacterial therapy are carried out. Antibiotics are prescribed taking into account the sensitivity of the isolated microflora, the duration of the course is up to 3 days of normal temperature.
In the proliferation phase, when there is no exudate and the wound is filled with granulations, local treatment is made more gentle. Bandages are cut (so as not to injure the granulation tissue), the wound is not washed. Ointments that promote tissue regeneration are injected into the wound. They carry out active physiotherapy (UHF, laser and magnetic therapy).
Physical methods of wound treatment
Physical methods include an open method of treating wounds without a bandage. It is currently rarely used. The basis of open wound treatment is the bactericidal effect of light, as well as the drying and oxidizing effect of air. The wound surface should be in such a position that the best flow of the discharge is ensured. The edges of the wound are lubricated with vaseline so that the skin does not macerate; the crusts formed around the wound are removed with tweezers. This method allows the use of light treatment of wounds (sun, quartz irradiation, etc.).
A closed method of wound treatment is more common. A bandage is applied to the wound, which sucks the secretion from the wound. To do this, a bandage is applied from dry sterile gauze with a significant amount of suction material (lignin, cotton wool), and the pus that is released in the wound is immediately absorbed by the bandage, as a result of which the absorption of toxins into the patient’s body from the wound decreases and the bacteria present in the pus are removed. All this creates conditions conducive to wound healing.
Bandage with drains. The use of drains, i.e. rubber or glass tubes inserted into the depth of the wound, is based on the same principle of sucking pus from the wound into the bandage. The difference between this method and the previous one is only that when it is applied, pus flows into the bandage through the tubes. It is possible to change bandage with drains less often. Such options are used for wounds with abundant purulent discharge. It is easier to remove and insert drains than tampons. The disadvantages of drains include the possibility of the formation of a bedsore on the wall of a vessel or intestine during a prolonged stay of drainage in the wound, due to pressure on the tissues and blood supply disorders. Drains are often replaced with rubber strips from gloves. With physical methods of wound treatment, the harmful effect of drying and tampons on granulations is underestimated: damage to them, deterioration of their growth and, thus, delayed wound healing.
Bandages with tampons. The introduction of gauze tampons into the wound, i.e. loosely laid strips of gauze injected to the bottom of the wound, is widely used. Unfortunately, tampons are absorbed only during the first day of their stay in the wound, and then they are soaked with pus, stop sucking properly. Therefore, it is necessary to change tampons often, which, as already mentioned above, is undesirable.
With a small amount of thick secretions, its removal from the wound is even better achieved by using a wrung-out wet bandage in a 2% soda solution, which helps to dilute the pus. In addition, wet tampons less injure granulations when they are inserted into the wound.
Dry and wet tampon-free bandages are widely used. No tampons or drains are injected into the wound. When bandaging, the pus is wiped only around the wound, without touching it in depth. Bandages are made as rarely as possible – after 3-4 days, the suction material is placed only on top. The bandage should not stick to the surrounding skin, otherwise the absorption of pus into the bandage will stop. The skin around the wound is best lubricated with sterile vaseline. This method gives especially good results when there are no severe infectious phenomena on the part of the wound, as well as in the second period of wound healing – when its granulation begins.
To make the wound less injured during the change of bandages, an ointment dressing is widely used. It is most suitable during the period when the wound has already been cleared of decay and is in the stage of granulation and epithelization. The dressing consists of gauze applied externally to the wound, and its surface adjacent to the wound is smeared with some ointment. Choose an ointment that does not irritate the granulation and is easily sterilized, for example, sulfidine emulsion, etc. Such a bandage is indispensable when applied to extensive granulating surfaces. With excessive growth of granulations, their protrusion above the edges of the surrounding skin, which slows down wound healing, they try to delay their growth by cauterizing granulations with lapis solution.
A bandage with a hypertonic solution. The absorption of pus from the wound occurs even more strongly when using tampons moistened with a solution that attracts water from the tissues; for this, a 10% solution of table salt, a 25% solution of magnesium sulfate is used. The use of hypertonic solutions is based on self-washing of wounds by enhanced lymphatic secretion from wound tissues into a bandage. Thanks to this constant current, toxins are removed from the wound into the bandage and the osmotic state of the wound changes, dead tissues are rejected faster, and a dry lifeless wound gets a healthy appearance due to the development of normal granulations. Bandages are changed daily or every other day.