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
