MYTH VS. FACT - WOUND HEALING
When it comes to healthcare there have always been myths. There are small, relatively harmless myths, for example people believing that all gluten-free foods are healthy. Then there are bigger myths, such as people believing that vaccines cause autism, which lead to a decrease in vaccination and rise in preventable-diseases. It’s difficult to pin-point where these myths originate from and why they persist so strongly in the face of overwhelming scientific evidence. Perhaps it’s because health is not an exact science; we are learning constantly, technologies change regularly and new research is always being conducted. It could also be because some health topics are complicated and can’t be reduced to simple truths; this flies in the face of our desire to simplify and categorise things in a modern, busy world. Whatever the reason it’s important that before we decide something is an absolute truth, we seek advice from a relevant healthcare worker and/or do some serious research.
Working as a Practice Nurse I see patients for a variety of different reasons but a large part of my work is wound care. This means I see acute accidents such as cuts and lacerations, sports injuries, post-operative wounds, chronic ulcers, burns and everything in between. One of the myths I see most regularly through my work is the idea that it is better to let a wound ‘dry out.’ What does this mean? Essentially the idea is that rather than keeping a wound covered, you leave it open in the air until a scab forms. The origin of this myth is easy to pin-point; it actually used to be considered best practice to let a wound dry out and so healthcare workers were telling people that for years. The belief was that it closed faster when it was dry and the scab formed a natural barrier. As the years have progressed and our knowledge has improved we can now confidently say however that this is a myth which was actually dispelled in the early 1960s! It is not better to let a wound dry out; wounds heal best with a moist, covered environment. Let’s find out why:
-Epithelialisation, or the formation of new cells, occurs twice as face in a moist environment. Furthermore, if a scab forms, this process is compromised every time the scab is broken.
-Letting a wound ‘dry out’ means allowing it to air-dry. This open wound however is the perfect entrance for pathogens (or germs), meaning your risk of infection is greatly increased! If a wound gets infected, the healing process is slower still and scarring is more likely to occur.
-Keeping a wound moist will involve regular cleaning and dressing changes, which will reduce cosmetic damage. Wounds heal from the bottom upwards; regular cleaning and dressing changes allow the wound to rise and become level with the rest of the skin. If a wound heals underneath a scab it is likely to heal in a concave shape because the new cells cannot rise fully.
-It’s important to note here that moist does not mean wet. The wound itself should be moist, but the surrounding skin needs to be dry. If your wound is oozing a lot, or the dressing gets soaked in the shower, etc., it’s time for a dressing change. Surrounding skin that gets wet can become macerated and thin and then also breakdown, expanding the wound area.
Now that you know why this method is best, how do you achieve this ideal environment? Regular dressing changes and wound cleaning is going to help keep a wound moist. If you’re not confident with this, that’s what I’m here for! Head to your local doctor (preferably one with a Practice Nurse for wound care!) and it can be done there. There are also special dressings you can buy which are designed purely to create this environment; ask your doctor, nurse or pharmacist about these!
Time to bust a quick myth-within-a-myth! Aside from patients presenting to work with dried-out wounds, I also see a lot of wounds that are covered in Betadine or Iodine. These substances are great INITIALLY for wound healing however they’re non-selective, meaning that they also remove good, essential bacteria. Theoretically after the first use of Betadine/Iodine you have removed all surface pathogens and so if used daily you are just stripping away the good bacteria, which will also delay wound healing.
As with most health concerns it is best to decide on a course of action with a healthcare worker. If you’re worried about a wound, no matter how severe, see your doctor or Practice Nurse. They can create a treatment plan for you, give you tips to manage the wound at home and also determine if it’s a wound that necessitates a Tetanus booster! Tetanus is found in not only rusty metal, but also animal saliva (e.g. pet bites), dirt (e.g. gardening accidents) as well as gravel and rocks (e.g. falling at the beach or outside). It’s also essential to see a healthcare worker because every wound is different and needs an individual plan. This information is general best practice however is not recommended for all wounds. There is no harm in being proactive and getting advice from a professional.
Myths are everywhere in healthcare. Misinformation spreads rapidly and we often believe that what we hear most often is correct. Thank you for taking the time to watch this episode and read this article; hopefully together we can work to reduce these myths slowly over time.
References/ Suggested Reading:
Benbow, M. 2008, ‘Exploring the concept of moist wound healing and its application in practice’, British Journal of Nursing, vol. 17, no. 15, pS4.
Brown, D. & Edwards, H. (eds) 2012, Lewis’s medical-surgical nursing: Assessment and management of clinical problems, 3rd edn, Elsevier, Chatswood, NSW.
Crisp, J. & Taylor, C. 2009, Potter & Perry’s: Fundamentals of Nursing (3rd edn), Mosby Elsevier, Chatswood, NSW.
Martin, B. & Rawlings, R.N. 2011, ‘Pearls for Practice: Moist Wound Healing’, Ostomy Wound Management, vol. 54, no. 4, pp. 10.