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Writer's pictureDr. Erum Ilyas

Bandages | How to care for a wound

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Photo: Wix

How long does it take to heal a skin abrasion?

The length of time it takes to heal is generally dictated by 3 factors:
  • Depth of the abrasion

  • Size (width) of the abrasion

  • Location of the abrasion

Wounds generally heal like a purse string - from the outside in and from the bottom up. The deeper and the wider the abrasion, there will be more healing time required to have the area ‘fill in’.
Abrasions located on the legs and particularly below the knee will take much longer to heal as the circulation is generally not as great as elsewhere. Most shallow and superficial abrasions located above the knee and managed appropriately can potentially heal within a week to 10 days.
The wound below is an abrasion I saw last year after sliding on turf. It took 3 weeks to proceed from the first photo to the second given the size of the area involved. Overall it had healed without needing dressings after about 2 weeks. The pigment started to recur by about week 3. Today there is no evidence of the wound left.

What is the best home remedy for skin abrasions?



The biggest mistake people make that adds to the healing time is letting wounds dry out or exposing them to air. Our skin cells heal by migrating across a wound to heal it like a purse string. If the area dries out, the skin cells will not be able to migrate, and wound healing will be delayed. If you allow a scab to form, then this will serve as a roadblock to prevent or delay healing as well as have a higher risk of scar formation.


The best steps to take in managing a wound:


  1. Cleanse the wound gently. If a saline or sterile water is not available, running water is best. Allowing soapy water to run over the wound may sting less than applying soap directly to the wound.

  2. If there is just slight oozing or seepage in the wound, this is to be expected if the wound was deep enough to reach the dermis. If there is active bleeding, apply vaseline to a piece of gauze then use the gauze to apply direct pressure to the wound for 10 minutes- without peaking. The purpose of the ointment is to allow the gauze to lift without pulling the scab and triggering more bleeding. 10 minutes ought to provide adequate time for clotting. If active bleeding does not stop, please contact your doctor, consider urgent care or ER visit or call 911 for help.

  3. Apply petroleum jelly or an antibiotic ointment and a nonstick dressing. From a healing perspective, in the absence of an infection, petroleum jelly is sufficient to promote wound healing. Using petroleum jelly or white petrolatum also reduces the risk of contact dermatitis. If there is significant pain, discomfort, or discharge from the wound, seek the advice of a medical professional and consider the use of antibiotic dressings or oral antibiotics if needed.

  4. If the wound is on an extremity, consider the use of coflex or coban to hold the dressing in place. The use of this type of wrap can reduce the irritation from adhesive in bandages. Change it daily until the area heals.


Are there some good items to keep on hand for a first-aid kit?

Consider keeping a bag with some basics in your car or home.






What is the best way to bandage cuts and scrapes?


Patients are often shocked when Dermatologists offer bandaging advice. There are so many myths that surround wound healing that many wounds are mismanaged placing them at a higher risk for scarring or complications.
The first step in managing a wound is to gently cleanse the wound. Often using clean water or normal saline poured slowly over the wound allows for gentle movement of water over the wound that can also pull away dirt and debris. Soapy water squeezed over the wound is also reasonable to help cleanse followed by plain water or saline to remove any residual soap.
If the wound is a “clean wound”, meaning there is no evidence or high risk of dirt, debris, or foreign material such as glass or gravel, following the cleanse, the wound can be gently blotted to dry the area. It is reasonable to use plain vaseline, Aquaphor, or an antibiotic ointment generously over the wound. Follow this with a nonstick dressing such as telfa to avoid the bandage sticking to the wound on removal, and then paper tape or coflex to hold this in place. Change this every 24 hours until the wound has healed. Wounds healed like a purse string from the outside in and the bottom up. Once the surface has healed, then it is reasonable to discontinue dressing changes.
If the wound is not “clean” and there is evidence of debris, this may need to be gently cleaned or removed. It is best to see a medical professional as it can be difficult to identify the areas to be treated and avoid risking an infection. After the debris has been cleaned, the dressing changes as described above can be used with the potential need for oral antibiotics if deemed necessary by your doctor.
The 2 biggest misconceptions about wound healing on the need for antibiotic ointment and the belief of needing a wound left open to the air to “scab” and accelerate healing. The most common challenge I find in dealing with nonhealing wounds is the use by the patient of OTC antibiotic ointments that they may be allergic to. This can result in contact dermatitis on top of the healing wound leading to delayed wound healing. The belief that a scab must form is also a myth as our skin does need a moist environment for skin cells to migrate across to help heal faster and with a lower risk of scarring. When a scab forms, this serves as a “roadblock” for skin cells to migrate across the wound either delaying the healing process or leading to the development of a depressed scar.


What are "stop bleeding bandages"?



Stop-bleeding bandages are usually kaolin-impregnated gauze bandages.

Kaolin is an aluminum silicate mineral derived from clay. It is thought to work as a hemostatic agent by activating the clotting cascade. It activates the Hageman factor (factor XII) when exposed to plasma. This in turn activates factors XI and prekallikrein. It has been studied in different settings. When used for ‘high flow’ wounds, meaning ones with significant oozing, it is thought to be capable of activating the clotting cascade. For superficial wounds or post-operatively in some surgical settings, it has not been shown to be as effective. This is likely because of the exposure required to the factors responsible for triggering the clotting cascade requires high flow whereas surgical bleeding may not meet that criterion.

When it comes to significant wounds for those on blood thinners, especially on the legs where it’s possible to trigger excess bleeding when varicose and spider veins are affected, the use of these bandages may be effective. However, for minor abrasions, superficial cuts, and scrapes, regular bandages or liquid bandaid will likely be as effective or more so.

Stop-bleeding bandage options available:

Bandage

Details

​Quick Stop by Curad

​Contains a cellulose-derived product that forms a soft jelly when in contact with blood. I found many papers in the peer-reviewed literature on this product.


Quick Stop uses a cellulose-derived hemostatic agent. This is thought to work by absorbing the blood. There is a hydrogel component responsible for creating a barrier for blood and adhering the patch to the bleeding site. Some studies show that it loses its adhesion to the wound at the 2-hour mark.

​HemCon Chito Gauze

​This is gauze with chitosan. Again, I found many papers in the literature on this product.


Collagen-derived hemostatic agents using chitosan are more effective than cellulose-derived products at reducing swelling, and the hemostatic effects last longer.

​Bleed Stop

​Powder form that you sprinkle on a wound, containing amylopectin derived from potatoes

​Wound Seal

​Powder form that you sprinkle on a wound, containing potassium salt and a polymer.


Microporous polysaccharide hemospheres are derived from potato starch. It is known to enhance platelet activity triggering clotting factors and the coagulation cascade within minutes. The ingredient works well.


Potassium salt-based products tend to work fast when it comes to hemostasis. Blood is concentrated by the product and forms a scab quickly. The scab will fall off on its own once ready.

How should a consumer who is taking anti-coagulants decide which type of product to purchase?


Choosing a hemostatic agent while on anti-coagulants really depends on the type of wound. For superficial cuts or abrasions, there will not be much difference in the effectiveness of these products. However, for deeper wounds with some flow choosing a product with prolonged activity such as a kaolin-based, potassium-based, or collagen-based product may be better suited. That being said, the studies around these products are based on surgical use primarily. The concentration of these ingredients in these products is difficult to state given that they are not listed as active ingredients with associated concentrations. All these products (including kaolin) seem to require exerting pressure in order to work. When these products are used in the surgical setting, one of the reasons for use is to obtain hemostasis in delicate areas where applying pressure may not be easy or possible. The fact that all of these products require pressure to work makes me suspect the concentrations of these ingredients may not be at the levels studied in the medical literature.


Are there any precautions one needs to take when using a “stop bleeding” bandage or product?

The most important precaution to take is to make sure the wound is cleaned before using. If there is a tear in the skin, ensure that the skin is re-approximated if possible prior to using these to have a better potential to speed healing.

Are there any precautions when using liquid bandages? And why would you use a liquid bandage as opposed to a stop-bleeding bandage?

A liquid bandage is a nice choice for wound care. The key is to dry the wound as much as possible as it takes some time for the liquid bandage to form a seal over the wound. I tend to prefer liquid bandage simply because of the seal it creates making wound care a little easier.


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