Sunday, June 29, 2014

Treating Wounds

Treating Wounds
A wound is a break in the tissues of the body. Some injuries, like cuts and scrapes,

are called open wounds; others, like deep bruises, are called closed wounds. They are

usually caused by external forces such as motor vehicle accidents, falls, and the

mishandling of sharp objects, tools, machinery and weapons.



All wounds need first aid (and medical attention if the wound is serious) in order to

ensure proper healing and to avoid infection.



For the last several years, evidence has suggested that chronic wounds may be growth

factor deficient or represent a microenvironment hostile to the repair process. More

recently, however, there is new evidence suggesting that wounds may not necessarily be

deficient in

growth factors, but that the stimulatory action of the peptides may be prevented from

being expressed.



Matrix degrading proteinases are proenzymes that need to be activated and are

considered to be the physiologic mediators of matrix degradation. The prototypic one is

interstitial collagenase, but there are at least ten of these enzymes that are secreted as

zymogens. Stimulated by growth factors and by extracellular matrix, they all utilize zinc

with a zinc atom binding at the center of the molecule at a conserved sequence. They are

stabilized by calcium and inhibited by various chelators such as the tissue inhibitor of

metalloproteinase. It is clear that collagenases are present in acute wounds, but little

or nothing is known about their possible role in chronic wounds.



Chronic wounds, including pressure ulcers and venous ulcers, are characterized by the

presence of fibrin within the wound bed and surrounding tissues. Fibrin accumulation in

acute wounds is removed within days, but it is not degraded in chronic wounds. Knowledge

of the process of fibrin formation and polymerization that has accumulated in recent years

may provide the basis for understanding the persistence of fibrin in chronic wounds. The

role of fibrin retention and the adherence of other molecules to it in interacting

with cytokines and growth factors in the wound healing process have just begun to be

investigated.



An important focus of wound healing research is the improvement of
patient care through the interdisciplinary collaboration between
clinicians and basic scientists. Restoration of physical integrity and
function of the injured or diseased tissue can best be
accomplished by integrating bio/molecular technology with clinical
treatments as clinicians and basic scientists work together. Examples
to encourage opportunities for clinicians to collaborate with basic
scientists include:





  • Investigations designed to determine the biological or molecular

    reason for successful wound healing with currently used clinical

    therapies, such as electrical stimulation, laser, or nutritional

    regimens. For example, clinicians have reported faster healing of

    pressure sores with patients on high protein diets. In order to

    identify the pivotal amino acid, methionine, cysteine, or arginine

    might be studied. Because zinc is a necessary cofactor of DNA

    polymerase and reverse transcriptase, studies could be pursued to

    determine whether or not the healing impairment associated with zinc

    deficiency is due to an inhibition of cellular proliferation.


  • Investigations designed to identify specific biological/molecular

    markers that could be used to define standardized outcome measures.

    For example, various dressings such as hydrocolloid, polyvinyldiene,

    polyethylene, polyurethane, and human skin are used in health care

    facilities to increase the rate of epithelial healing. Can serum

    protease inhibitors or tissue inhibitors be identified in the fluid

    of chronic wounds to standardize use of specific wound cleansers and

    dressings in the treatment of pressure sores/venous leg ulcers?




Serious complications may occur to neglected wounds and, at times, even the best cared for

wounds. If you notice any of these signs when examining your wounds, you should see a

doctor immediately:





  • Redness, excessive swelling, or tenderness in the wound area


  • Throbbing pain or tenderness in the wound area


  • Red streaks in the skin around the wound or progressing away from the wound



  • Pus or watery discharge collected beneath the skin or draining from the wound




  • Tender lumps or swelling in your armpit, groin or neck


  • Foul odor from the wound


  • Generalized chills or fever




Always wash your hands with soap before and after giving first aid in order to avoid

infection.



The following types of wounds are more likely to become infected: bites, punctures,

crushing injuries, dirty wounds, wounds on the feet, and wounds that do not receive prompt

medical attention.



Scrapes and abrasions are superficial injuries to the skin and mucous membranes.

Although scrapes and abrasions are relatively minor injuries, like all open wounds they

are painful and highly susceptible to infection. Following an abrasion or scrape, a

physician should be consulted about antitetanus injections. If dust and grit are left in

the wound, scars may form on the skin. Any foreign matter should be removed before the

wound has healed.



Clean the abrasion with soap and water, and rinse thoroughly. If the victim has other

injuries or extensive abrasions, summon medical aid. Do not remove any scabs that may form

over the injury. They will fall off when the wound has healed. If scabs are removed before

the wound has fully healed, the abrasion may begin to bleed again.



The list below includes wound care medications and other helpful items. Remember, if

you have a serious injury or illness, you should seek professional medical attention.





  • Analgesic - preferably acetminophen


  • Antacid


  • Anti-inflammatory - preferably Ibuprofen


  • Calamine lotion


  • Expectorant cough syrup


  • Decongestant (pseudoephedrine)


  • Ointment


  • Antiseptic solution (Hydrogen Peroxide)


  • Petroleum jelly


  • Sunscreen (SPF-15 or higher)




Wood sage, chickweed, goldenseal, myrrh, echinacea, slippery elm; effective as

poultices and/or washes.



See also: Skin Wounds






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