Two basic types of wounds

There are 2 basic types of wounds: (1) red, raw open wounds that are missing skin and oozing liquid and (2) closed dry wounds where skin edges are touching all along the cut and held together with stitches, staples, or glue. We will start with the care of raw open wounds.

There are many nonsurgical strategies for looking after wounds.1 The following is an affordable group of strategies that can easily be taught to patients and their families using simple language. This paper avoids complicated medical words so patients, medical students, and doctors all over the world can read and apply the methods we describe. Plastic surgeons have been using these simple strategies with great success for decades. This approach allows people to look after their own wounds at home at minimal financial and environmental costs with simple materials.

The most important part of the care of raw wounds is to keep them clean and greasy so the tissues do not dry and die. Wounds all over the body can be treated in this manner. Below, we illustrate 4 typical case examples where we use this approach in complex wounds of the foot, hand, fingertips,2 and face with exposed bone, cartilage, joints, and tendons. In some cases, if there are deep, open, caved in wounds, we add a vacuum assisted dressing to accelerate flattening the cave.

All raw wounds will heal if there is enough blood supply to the area, and if the raw tissues are not allowed to “dry and die.” Open raw wounds will heal with proper care even if there is exposed fat, bone, tendon, muscle, or joint. Red is raw; pink is healed. If the wound is red, it has lost the waterproof barrier of skin and it is an open or raw wound that oozes liquid as our bodies are 80% water.

How to Clean Raw Wounds?
Fresh raw wounds love to be showered daily with clean water. Tap water is legislated to be almost sterile for drinking in North America. If the shower water is “dirty,” we can rinse the raw wound with bottled drinking water after letting the “dirty” shower water clean the rest of the body.

Sterile water or sterile saline is not necessary for cleaning wounds.3–5 There is no need to rub soap into a wound, but small amounts of soap or shampoo getting into a wound will not be harmful and can be rinsed out at the end of the shower. If we take a bath, we can rinse the wound with clean water at the end of the bath. Damaging nonwater liquids such as alcohol or undiluted hydrogen peroxide can kill tissue and should not be used to wash an open wound.

The displays of secondary healing over exposed bone, joint, tendon, and ligaments with Coban and Vaseline in fingers; see Video 2 [online], which displays more complex facial wound managed at home with tap water, Vaseline, and clean bandages until the lip and cheek contracted in ready for forehead flap; see Video 3 [online], which displays a patient’s learning how to clean and dress wound themselves using daily shower, Vaseline, and nonsterile dressings).

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