Treatment of acute wounds relies on enhancing and focusing the processes
of the skin.
Promotion of epidermal migration and wound coverage is
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
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
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
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
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...
procedures were not evidence based...p225
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.
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
healing medical guidelines
"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
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
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
This section pertains to piercing and salt
Isotonic: "when two solutions have equal solute concentrations (usually used
with regards to describing solution on either side of a membrane).
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.
Isotonic - having the same salt concentration as blood.
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.
Accessed online 01-01-2006