1. Types and Assessment of Wounds: The First Step in Care

Acute wounds are like sudden visitors: surgical incisions are neat and standardized with low contamination; traumatic wounds vary in shape and may contain foreign objects; burns are classified by depth into first-degree (epidermis), second-degree (dermis), and third-degree (full-thickness skin). These wounds generally follow a predictable healing timeline.

Chronic wounds are stubborn lingerers: pressure injuries commonly occur over bony prominences, diabetic foot ulcers often accompany neuropathy and vascular issues, and venous ulcers are mostly found on the inner lower leg. Their common feature is delayed healing, often lasting months or even years.

Wound assessment is the cornerstone of care.

Observe the wound's location, size, depth, and edge condition.

Identify tissue types: bright red granulation tissue indicates health, yellow necrotic tissue requires cleaning, and black eschar hinders healing.

Assess exudate: clear serous fluid is normal, yellow-green pus suggests infection, and pink may indicate bleeding.

Be alert for signs of infection: increased redness, swelling, heat, pain, foul odor, increased pus, or systemic fever.

Keeping the wound clean is key to preventing infection; regularly change dressings and promptly remove exudate and contaminants to reduce infection risks.

2. Wound Cleaning and Disinfection: Removing Barriers to Healing.

Maintaining wound cleanliness is crucial to prevent infection; regularly change dressings and promptly clear exudate and contaminants to reduce infection risk. For wounds with poor local blood circulation, physical therapies like warm compresses and massage can improve blood flow. Additionally, maintaining good lifestyle habits and posture to avoid prolonged pressure on the wound is necessary.

Cleaning is the primary step in wound care:

1. Wash hands and wear sterile gloves.

2. Gently rinse with saline or clean water to remove surface contaminants.

3. For deeper wounds, use a syringe to gently irrigate.

4. Avoid vigorous rubbing to prevent damage to new tissue.

Disinfectant selection must be scientific and cautious:

Saline: the gentlest and safest cleanser.

Povidone-iodine: broad-spectrum antibacterial but mildly toxic to new cells; concentration should not be too high.

Chlorhexidine: long-lasting antibacterial effect, low irritation, suitable for chronic wounds.

Hydrogen peroxide: only for early cleaning; frequent use damages healthy tissue.

Alcohol: strictly prohibited for open wounds; only for intact skin disinfection.

Important tip: rinse off disinfectant residues with saline after use to avoid chemical interference with healing.

3. Modern Dressings: Creating an Ideal Healing Environment.

The era of traditional gauze is over; modern dressings provide precise solutions based on wound characteristics:

Hydrocolloid dressings (e.g., Comfeel): maintain a moist environment, promote autolytic debridement, suitable for superficial wounds with minimal exudate.

Foam dressings: highly absorbent, provide cushioning protection, suitable for moderate to heavy exudate wounds.

Hydrogel dressings: provide moisture, soften necrotic tissue, used for dry, scabbed wounds.

Alginate dressings: strong absorption, form gel to maintain moisture, suitable for cavity wounds.

Antimicrobial dressings (containing silver ions, calcium alginate, etc.): control infection and reduce antibiotic use.

Dressing change principles:

Acute wounds: change every 1-3 days or when exudate soaks through.

Chronic wounds: change based on exudate amount and dressing type.

Assess wound progress at each dressing change and adjust care plans accordingly.