Wounds

A wound is a break in the structure of an organ or tissue caused by something outside the body. Most wounds affect the skin, the first line of defense against infection. Minor wounds include cuts, scrapes (abrasions), and puncture wounds. Other examples include bruises, punctures (made by pointed objects), incisions (clean cuts), contusions (may not break the skin but can cause damage), lacerations (jagged, irregular cuts), diabetic ulcers, and burns. While most minor wounds heal easily, some can worsen into chronic open sores that can become seriously infected. You may be able to treat minor wounds at home, but any animal bite or a cut greater than ½ inch long where you can see fat, muscle, or bone requires emergency medical care.

Signs and Symptoms:

The following signs and symptoms often accompany wounds:
Bleeding or oozing of blood
Redness
Swelling
Pain and tenderness
Heat
Possible fever with infection
Loss of function (or mobility)
Oozing pus, foul smell (in infected wounds only)

What Causes It?:

Accidents or injuries usually cause wounds, but can they can have any of the following causes:
Blunt or penetrating trauma
Surgery
Chemical injury
Thermal injury
Temperature extremes (for example, burns or frostbite)
Radiation.

Who's Most At Risk?:

The following risk factors are associated with wounds:
Age (older people are at higher risk)
Malnourishment, especially protein depletion or zinc deficiency
Vitamin deficiencies, especially vitamin C
Poor general health
Steroid use
Radiation and chemotherapy
Diabetes
Smoking
Weight loss or obesity.

What to Expect at Your Provider's Office:

If you receive a serious wound, you should see your health care provider. Your health care provider will determine the extent and severity of the injury, possible contamination, and conditions that might complicate treatment. Your health care provider may also order laboratory tests, such as a blood test and urinalysis, as well as a culture to check for bacteria in the wound. They may also suggest you get a tetanus shot or a tetanus booster.

Treatment Options:

Prevention:

Most wounds are accidental and often preventable. Once you've received a wound, carefully cleaning the wound and using antibiotics as needed can usually prevent infection and other complications.

Treatment Plan:

Treatment depends on the type and severity of the wound. Some wounds, such as clean lacerations, are relatively minor and can be treated at home. Clean the wound with water, and stop the bleeding by applying gentle pressure. Apply an antibiotic cream such as Neosporin, then cover the wound with an adhesive bandage. Change the bandage every day or when it becomes wet. If any redness spreads from the wound after two days, or if you see a yellow drainage from the wound, see your doctor immediately.

Other wounds -- particularly those in which the bleeding will not stop, deep cuts that show muscle or fat, or animal or human bites or fishhook injuries (do not remove the hook) -- can be serious. Apply pressure to the wound to stop bleeding, and immediately seek emergency medical care.

Some wounds may involve a loss of tissue and require a skin graft, where a piece of skin is cut from a healthy part of the body and used to heal the damaged area.

Your health care provider will determine whether the wound can be closed immediately, by suturing or grafting, or whether it must be kept open because of contamination. Infected wounds are never closed until the wound has been successfully treated.

Drug Therapies:

Your health care provider may prescribe the following medications:
Analgesics, or pain relievers
Antiseptics, to clean contaminated wounds
Antibiotics for infections or sepsis (destruction of tissues by disease-causing bacteria, accompanied by a strong odor)
Medicated dressings
Corticosteroids
A tetanus shot.

Surgical and Other Procedures:

Surgery is sometimes needed for severe wounds. This may involve cutting away burned tissue and removing contaminated tissue, skin grafting, and draining wound abscesses (pus surrounded by inflamed tissue).

Complementary and Alternative Therapies:

You can use complementary and alternative therapies for minor household injuries or after more serious injuries have already received thorough medical attention. If you have doubt whether or not your wound is serious, do not use alternative therapies before speaking with your doctor. Never apply topical remedies to any open wound without a doctor’s supervision.

Nutrition:

Potentially beneficial nutritional supplements include those listed below. You can also take these supplements before surgery to reduce healing time. Lower the dose or stop use when your wound has healed.
Beta-carotene (250,000 IU a day) or vitamin A (25,000 IU a day) to promote healthy scar tissue. These are high doses, and you should not take them for longer than 1 - 2 weeks without your health care provider's supervision. Reduce dose to 50,000 IU of beta-carotene and 15,000 - 25,000 IU of vitamin A daily after 2 weeks. Do not take high doses of vitamin A if you are pregnant, trying to conceive, or have liver disease. Talk to your doctor before taking vitamin A if you are scheduled to have surgery.
Vitamin C (1,000 mg two to six times per day) helps skin heal by enhancing tissue formation and strength. Lower dose if diarrhea develops.
Vitamin E (400 - 800 IU a day) promotes healing. May be used topically once the wound has healed and new skin has formed. Higher doses may be beneficial for healing burns. Talk to your doctor before taking vitamin E if you are scheduled to have surgery.
Zinc (10 - 30 mg a day) stimulates wound healing. You can also apply zinc topically in a cream to speed wound healing. Do not apply to open wounds. If you take zinc long-term, ask your doctor if you also need to take copper.
B complex vitamins (1,000 mcg per day), including B1 (thiamine) and B5 (pantothenic acid), may aid wound healing and skin health.
Bromelain (40 mg four times a day between meals) reduces post-surgical swelling, bruising, healing time, and pain.
Glucosamine (1,500 per day in divided doses) and chondroitin sulfate (400 mg two times per day) may help heal wounds by encouraging the repair of connective tissue in the body, but studies are needed to confirm the effect.
L-arginine (17 - 25 g per day) has been used to improve healing time in surgery patients. Use caution if you are prone to herpes outbreaks, and talk to your doctor.
Whey protein, taken as a daily protein shake, provides essential amino acids for wound healing and tissue repair.
Honey has been used topically as a dressing after surgery, and some studies suggest it helps wounds heal without becoming infected. Talk to your doctor before using honey on minor wounds, and do not apply honey to an open wound.

Herbs:

Certain herbal remedies may offer relief from symptoms and help wounds heal faster. Herbs are generally available as dried extracts (pills, capsules, or tablets), teas, or tinctures (alcohol extraction, unless otherwise noted). People with a history of alcoholism should not take tinctures. Dose for teas is 1 heaping tsp. per cup of water steeped for 10 minutes (roots need 20 minutes), unless otherwise noted.

Applied to skin:

Never apply herbs to open wounds unless under a doctor's supervision.
Aloe (Aloe vera), as a cream or gel. Aloe has been used traditionally to treat minor wounds and burns, but scientific studies about its effectiveness vary. In one study, aloe appeared to make surgical wounds take longer to heal.
Calendula (Calendula officinalis), or pot marigold, as an ointment or a tea applied topically. To make tea from tincture, use 1/2 to 1 tsp. diluted in 1/4 cup water. You can also steep 1 tsp. of flowers in one cup of boiling water for 15 minutes, then strain and cool. Test skin first for any allergic reaction.
Marshmallow (Althaea officinalis) as a topical ointment to help wounds heal and fight inflammation.
Tea tree oil (Melaleuca alternifolia) as oil or cream. Apply two times per day to reduce inflammation. Do not use tea tree oil to treat burns.
Gotu kola (Centella asiatica) as a cream containing 1% of the herb, to help heal wounds.
Chamomile (Matricaria recutita or Chameaemelum nobile), as an ointment or cream, to help heal wounds.
Echinacea or coneflower (Echinacea spp.) as a gel or ointment containing 15% of the juice of the herb.
Slippery elm bark (Ulmus rubra or fulva) as a poultice. Mix 1 tsp. dried powder in one of cup of boiling water. Cool and apply to a clean, soft cloth. Place on affected area.

Taken by mouth:
Turmeric (Curcuma longa) is an anti-inflammatory that increases the effects of bromelain. Use dried extract 250 - 500 mg three times a day.
Gotu kola promotes connective tissue repair, supports normal wound healing, and prevents a scar from growing larger. Use standardized extract 60 mg one to two times daily, or 60 drops of tincture three to four times per day. Do not take gotu kola if you have high blood pressure or experience anxiety.
Coneflower and goldenseal (Hydrastis canadensis), used together, protect against infection. Use equal parts tincture 30 - 60 drops three to four times a day.
Dandelion (Taraxacum officinale, 2 - 8 g per day) is another herb with anti-inflammatory and antioxidant properties. Be sure you do not have an allergy to dandelion, and avoid taking the herb if you have liver or gallbladder disease, diabetes, or kidney disease, or if you take blood-thinning medication.
Pycnogenol (Pinus pinaster, 200 mg per day), an extract of the bark of a particular type of pine tree, helps promote skin health.

Homeopathy:

Before prescribing a remedy, homeopaths take into account a person's constitutional type -- your physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for each individual.

Some of the most common acute remedies for wounds are:
Arnica -- for bruised feeling and grief or shock from trauma. It should be taken immediately after injury and repeated several times throughout the day for 1 - 2 days after injury.
Calendula -- for wounds where the skin is broken but there are no other symptoms
Staphysagria -- for pain from lacerations or surgical incisions
Symphytum -- for wounds which penetrate to the bone
Ledum -- for puncture wounds
Urtica -- for burns
Hypericum -- for injuries and trauma to nerves
Wala -- for keloids

Prognosis and Possible Complications:

Most minor wounds heal quickly. For more severe wounds, the prognosis depends on the extent of the wound, as well as any infection that might develop. There are several complications associated with wounds: infection, keloid scar tissue formation (an overgrowth of scar tissue), and gangrene (which may require amputation). Wound hemorrhage, sepsis, and tetanus (a potentially fatal infection of the nervous system) are also complications that can occur.

Following Up:

Check for signs of bleeding, discoloration, or swelling in and around the wound. Tell your health care provider if you have fever, increasing pain, or develop drainage, which may indicate an infection.