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Tattoo Healing
Treatment of acute wounds relies on enhancing and focusing the processes of the skin.
Promotion of epidermal migration and wound coverage is essential....
A humid environment enhances healing. Therefore dressings usually are made to maintain moisture in the wound. Application of ointments, medications, or dressings is designed to optimize the local environment."p762
Dermatologic Clincs, Vol 11, No. 4

A scab or crust is a formation of necrotic cells, necrotic tissue, fibrin and blood products. Some components of the dermis are also present in the scab, including collagen and elastin fibers. The scab is a defensive reaction to protect the underlying tissue from the dry open environment. The skin sacrifices the exposed cells and tissue to form a protective barrier.
The scab is inhibitory to epidermal growth. A vapor-permeable membrane that provides a moist environment enhances superficial wound healing. The epidermal cells are slowed by a scab because the cells must migrate underneath the scab and travel farther. The epidermal cells must loosen the scab further slowing growth."p762

One author suggests that: "...plain petrolatum retards epithelialization more than occlusive dressings...too thick a layer of petrolatum ointment may be a mechanical barrier to cell migration and not allow the cells to adhere properly. Creams and lotions may be more effective at speeding epithelialization than petrolatum."
Dermatologic Clinics Vol 11 No. 4 p764


"Antibiotic ointment is a standard preparation that many dermatologists find useful. It has some potential to enhance epidermal wound healing and also provides a moist, antibacterial environment. It is not known to cure existing infections on its own." p 763

"Occlusive dressings can be very useful for rapid wound healing. Epithelialization takes 2 to 3 days with air exposure, but occlusion shortens the healing time to 18 to 24 hours. Occlusive dressings are advantageous for wound healing because the occlusion speeds healing, prevents environmental trauma, and keeps bacteria out of the wound. p764
Management of Acute Wounds, L.S. Moy, MD Dermatologic Clinics Vol. 11 No.4 Oct.1993

The use of antiseptics to kill the microflora in the wound environment can alter wound healing. Most harsh chemicals that make up antiseptics harm not only microflora but also delicate, newly forming skin.p744

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Keep in mind that it is the skin itself that does the work of repair, not us, and will repair itself  sooner or later, not because we are using the miracle healing ointment of the week, but in spite of the challenges we present to the skin. 
(Thank Goodness for that.)

As indicated above, our job is to suggest a method that will promote the skin's ability to heal itself based on medical and scientifically accepted recommendations.


Infection Control in the Community
 J. Lawrence, RGN, ONC, ENB, D. May, RGN DMS, Eds. Churchill Livingston, 2003

"Over the past decade, Many questions have been raised regarding infection control and prevention in very diverse community settings. This book (ICC) has been written in response to those questions, ranging from situations in a patient's home to tattooing and piercing establishments. The authors are all highly experienced in their field....This book provides a resource for primary care staff to ensure that evidence-based practice is being applied..." from the Preface

"ICC is a primary reference source to insure that, where applicable, the evidence base is being applied to infection control practice and procedures...the content is applicable to a variety of settings in primary care: people's own homes, nursing and residential homes, prisons, tattooing and piercing establishments, schools, nurseries, dental and GP surgeries."

Wound management techniques...have been...ritualistic... (and)
procedures were not evidence based...p225

This statement certainly applies to tattoo and piercing in a big way.  Aftercare instructions regularly contradict published established medical procedure, for example, washing the wounds again and again during the day. Health Departments have regularly been fooled into thinking the cascade of healing events and requirements for speedy healing don't apply to tattooing or piercing.
(Comment by Wes Wood)

The message is being emphasized ... An understanding of the wound healing process...is essential...p226

...which strongly links evidence-based practice with quality care. p225

Some areas of wound care have been well researched,
and the guidance is clear....p225  

Until further research is available the reader is advised to use the following technique... p236

established wound healing medical guidelines


Wound Cleansing
"We need to consider when we should cleanse, how, and with what. The purpose of wound cleansing is to remove 'foreign bodies', excess exudate and bacteria from a wound. This is particularly important in infected wounds or those at risk for infection."  p.239

The purpose of washing is to remove foreign matter, bacteria and excess exudate (exudate that is beyond the borders of the wound because that exudate can cause harm to surrounding intact skin).  (Comment: Wes Wood)

Removing Excess Exudate
Exudate is required on the wound surface to maintain phagocyte levels, as well as other wound-healing hormones and chemical stimuli. Wound irrigation will remove these and is therefore best avoided." p.239-24

Removing (washing) exudate from wound area is not the best practice for wound healing. (Comment: Wes Wood)

The rationale for different cleansing solutions.
"If wound irrigation is deemed necessary...

(to remove foreign matter, bacteria and excess exudate)

a decision (a judgment call is made)...sterile or clean...

Many nurses are now using non-sterile (for example examination gloves and washing with water. So when tap water is used)...Tap water is not isotonic...water may be drawn into the tissues ...through the cell walls, causing the cells to rupture. Minimal contact time is therefore advocated. (with non-isotonic fluids.) Isotonic (normal) 0.9% saline is currently the sterile solution of choice...."

Antiseptics for wound cleansing.
"In general they should only be used for a specific purpose, as an adjunct to antibiotic  therapy..."p240
(In plain words: when there is an infection present and the patient is taking systemic antibiotics orally or intravenously. Wes Wood)
1. Elizabeth Scanlon, "Wound Care" in Infection Control in the Community edited by Jean Lawrence and Dee May, 225-250. London: Churchill Livingston
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This section pertains to piercing and salt
Definition:
Isotonic: "when two solutions have equal solute concentrations (usually used with regards to describing solution on either side of a membrane).
"http://www.biochem.northwestern.edu/holmgren/Glossary/Definitions/Def-I/isotonic.html

ISOTONIC: Relating to isotonicity or isotonia. Having equal tension; denoting solutions possessing the same osmotic pressure; more specifically, limited to situations in which cells can neither swell nor shrink. http://www.condell.org/libertyville/neurosurgery/neurology-glossary.php?a=I

Isotonic - having the same salt concentration as blood.
http://www.shortbowel.com/glossary/i.asp

Isotonic solution: A solution that has the same salt concentration as the normal cells of the body and the blood. As opposed to a hypertonic solution or a hypotonic solution. An isotonic beverage may be drunk to replace the fluid and minerals which the body uses during physical activity. http://www.medterms.com/script/main/art.asp?articlekey=4058
If a hyperosmolar solution was administered to a patient, this would tend to cause water to move out of the cell...water would move through the membrane from the side of lower solute concentration (or alternatively: higher H2O concentration) to the side of higher solute concentration...
If the red cells swell and rupture, the test solution is said to be hypotonic compared to normal plasma. If the red cells shrink and become crenated, the solution is said to be hypertonic. If the red cells stay the same, the test solution is said to be isotonic with plasma. The red cell membrane is the reference membrane. Red cells placed in normal saline (i.e. 0.9% saline) will not swell so normal saline is said to be isotonic.
http://www.qldanaesthesia.com/FluidBook/fl2_3.htm
Accessed online 01-01-2006
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