OTCs Today

Mary Warner

Wounds are defined as any injury that causes a break in the skin, including abrasions (from rubbing or friction) and lacerations (from a sharp-edged object). While abrasions extend only to the uppermost portion of the dermis, lacerations cut through multiple layers of skin. Care of each wound depends on how deep the penetration is and whether foreign bodies (e.g., glass, dirt, or any object that could cause infection) are present.

Immediate care of any wound includes washing hands to avoid infection, stopping the bleeding, cleaning the wound under running water and washing around it with soap, removing any dirt or debris from the wound, applying antibiotic cream or petroleum jelly to keep the surface moist and prevent scarring, and covering the wound with a bandage to keep it clean. (Minor scratches or scrapes don’t need to be covered.)

Healing process

Understanding the process of wound healing, which consists of three overlapping phases, can help to ensure proper care of each type of wound.

The inflammatory phase begins immediately after the injury and lasts approximately 3 to 4 days. It includes two primary processes: hemostasis and inflammation. During hemostasis, thromboplastin is released from the injured cells to form a clot and stop any bleeding. In the inflammation phase, collagen is formed to stimulate healing and epithelial cells migrate to cover the wound bed with an initial layer (just one cell thick) of new skin.

In the next phase of healing, the proliferative phase, the wound is filled with new connective tissue and covered with new epithelium. This phase starts on day 3 or 4 and continues for approximately 3 weeks.

Finally, the maturation or remodeling phase begins after approximately 3 weeks and peaks approximately 60 days after occurrence of the injury. The wound is completely closed by connective tissue and resurfaced by epithelial cells.

The healing process can be affected by several factors, including age, stress, inadequate nutrition, diabetes, obesity, cancer, alcoholism, and smoking. In addition, some medications—primarily those that interfere with clot formation, platelet function, inflammatory response, and cell proliferation—can affect wound healing.

Wound care

Dressings, sometimes combined with a bandage, are used to protect a wound, prevent infection, and allow healing. A dressing should be large enough to totally cover the wound, with a safety margin of about 2.5 cm on all sides beyond the wound. Dressings vary greatly in type and size, so it is important to select the correct dressing for use on a specific wound.

Gauze is cost-effective and readily available in a variety of forms, including pads and rolls, and is generally used in the care of burns and wounds that are bleeding, draining, or require debridement. Traditional gauze products must be held in place by surgical tape or a self-adherent wrap, although some newer adhesive gauze (e.g., Band-Aid Cushion-Care Adhesive Gauze Pads) are self-adhesive. Because gauze does not keep the wound moist, gauze dressing must be changed often to prevent the wound from drying out. Nonstick gauze is recommended over traditional gauze to avoid damage to the scab and new tissue, which often causes pain and delays healing.

Adhesive bandages are available in a variety of shapes and sizes and are cost-effective for minor wounds. They contain a nonadherent pad in the center, but many don’t provide a moist healing environment; thus, a topical skin protectant is recommended for use with these bandages. Specialized adhesive bandages are available, including clear bandages for discreet wound healing, and those with waterproof adhesives, antibacterial fabric, cushioned fabric, and highly durable adhesives. These bandages must be changed often due to their limited absorption ability.

Hydrocolloid bandages consist of an inner layer of gel-forming agents and an outer water-impermeable layer and are most useful for minor burns or blisters. When the hydrocolloids come in contact with moisture from the injury, they form gels and help protect the wound by absorbing excess fluid and maintaining moisture. These bandages often cost more than traditional adhesive bandages.

Transparent adhesive films are thin, elastic, waterproof polyurethane films that are permeable to gas but impermeable to bacteria. Because they aren’t highly absorbent, they should be used only for wounds with minimal excess fluid. They are particularly useful for areas such as elbows or knees that can be difficult to cover with a traditional bandage.

Liquid adhesive bandages are sprayed or brushed on the wound and form a clear, flexible coating. They may be preferred for cosmetic reasons or because of their flexibility on hard-to-cover areas. Some have antibacterial or antiseptic properties, and some may cause a burning sensation when applied. The adhesives are waterproof and may stay on for 5 to 10 days, which can sometimes be an advantage over traditional adhesive bandages. Liquid adhesive bandages should not be used on large areas of the body, over sutures, near the eyes, or on mucous membranes.

What to tell your patients

Patients should be advised to see their primary care physician if they see signs of infection on the skin or near the wound, including expanding changes in color, increasing pain, drainage, warmth, or swelling. They should keep the dressing clean and limit changes to avoid damaging the healing skin at the burn or wound. They should also be advised to get a tetanus shot if the wound is deep or from a dirty object and they haven’t been immunized for tetanus in the past 5 years.

For more information, see Chapter 41 of APhA’s Handbook of Nonprescription Drugs, available in the bookstore on pharmacist.com or the “Minor Burns, Sunburn, and Wounds” section of APhA OTC in PharmacyLibrary (www.pharmacylibrary.com). ■