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Wounds

A wound is a break in the skin, the first line of defense against infection. Minor wounds include cuts, scrapes, and puncture wounds. Other examples include incisions (clean cuts), lacerations (jagged, irregular cuts), diabetic ulcers, and burns.

While most minor wounds heal easily, some can develop into open sores that can become seriously infected. You may be able to treat minor wounds at home by washing the area with clean water and applying a bandage. But you should seek emergency care for any animal or human bite or a cut greater than ½ inch long where you can see fat, muscle, or bone.

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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
• Not being able to use or move the affected area
• 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:

• Surgery
• Heat or chemical burn
• Temperature extremes (frostbite)
• Radiation

Who is Most At Risk?

You may be at higher risk for wounds if you have these characteristics:

• Age. Older people are at higher risk
• Poor general health
• Steroid use
• Radiation and chemotherapy
• Diabetes
• Smoking

What to Expect at Your Provider's Office

If you receive a serious wound, you should get emergency treatment right away. The doctor will determine the extent and severity of the injury, whether it is likely to get infected, and anything 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. You may need stitches, as well as a tetanus shot or a tetanus booster.

Treatment Options

Prevention

Most wounds are caused by accidents. Make your home safe by removing any objects that might cause trips or falls, keep the water heater at 120 degrees, keep knives and hot pots and pans away from the edge of counters, and pay close attention when using knives. If you get a cut or wound, carefully cleaning and bandaging it can usually prevent infection and other complications.

Treatment Plan

Wound healing is most successful in a moist, clean, and warm environment. Some wounds, such as minor cuts and scrapes, can be treated at home. Stop the bleeding with direct pressure, and clean the wound with water. You DO NOT need soap or hydrogen peroxide. Apply an antibiotic cream, then cover the wound with an adhesive bandage. Change the bandage every day, or when it gets wet. If any redness spreads from the wound after 2 days, or if you see a yellow drainage from the wound, see your doctor immediately.

Other wounds can be serious. Get emergency care immediately if the wound will not stop bleeding or spurts blood. You should also get immediate care if the wound is from an animal or human bite, or if there is a serious puncture wound. If an object (such as a nail or fishhook) is still stuck in the wound, DO NOT take it out. Apply pressure to the wound to stop bleeding, and go to the hospital.

Some serious wounds may need 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 with stitches, or whether it should be kept open because of contamination. Infected wounds are not closed until the wound has been successfully treated.

Drug Therapies

Your provider may prescribe the following medications:

• Analgesics, or pain relievers, such as acetaminophen (Tylenol) or ibuprofen (Advil, Motrin)
• Antiseptics to clean contaminated wounds
• Antibiotics for infections or sepsis, caused by disease-causing bacteria accompanied by a strong odor
• Medicated dressings
• Corticosteroids
• A tetanus shot

Surgical and Other Procedures

Severe wounds may need surgery. 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 (CAM) for minor household injuries or after more serious injuries have gotten medical attention. If you have any question about whether your wound is serious, call your doctor before using CAM therapies. Never apply any herb or supplement to any open wound without a doctor's supervision.

Nutrition

Some nutritional supplements may help wounds heal, although not all have good scientific studies behind them. If you are having surgery, DO NOT take any herbs or supplements without your doctor's supervision. Lower the dose or stop use when your wound has healed.

• Beta-carotene or vitamin A to promote healthy scar tissue. Ask your doctor to help you determine the right dose. 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 helps the body make collagen and is essential to wound healing because it helps the body form new tissue. Lower dose if diarrhea develops. Vitamin C supplements may interact with other medications, including chemotherapy drugs, estrogen, warfarin (Coumadin), and others.
• Vitamin E promotes healing. May be used on the skin once the wound has healed and new skin has formed. Higher doses may help heal burns. Talk to your doctor before taking vitamin E if you are scheduled to have surgery. Vitamin E may interact with a number of medications. Vitamin E may increase the risk of bleeding. If you take blood thinners, ask your doctor before taking vitamin E.
• Zinc stimulates wound healing. You can also apply zinc to the skin 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. Very high doses of zinc may suppress your immune system. Some studies have found that high doses of zinc are linked to an increased risk of some cancers.
• B complex vitamins, including B1 (thiamine) and B5 (pantothenic acid), may aid wound healing and skin health.
• Bromelain, an enzyme that comes from pineapple, has reduced post-surgical swelling, bruising, healing time, and pain in some studies. Bromelain may increase the risk of bleeding. If you take blood-thinning medications, such as warfarin (Coumadin) or aspirin, ask your doctor before taking bromelain. People who are allergic to pineapple should not take bromelain.
• Glucosamine and chondroitin sulfate may help heal wounds by encouraging the repair of connective tissue in the body, but studies are needed to be sure. If you have asthma or diabetes, ask your doctor before taking glucosamine. Glucosamine and chondroitin can increase the risk of bleeding, especially if you already take blood thinners, such as warfarin (Coumadin) or clopidogrel (Plavix). Some doctors think glucosamine might interfere with some medications used to treat cancer. It may also interact with acetaminophen (Tylenol) and some diabetes drugs. Ask your doctor before taking glucosamine and chondroitin.
• L-arginine has been used to improve healing time in after surgery. It has also been applied to the skin to help heal wounds. Use caution if you are prone to herpes outbreaks, and talk to your doctor. If you have asthma, take medication for high blood pressure, or use Viagra, ask your doctor before taking arginine.
• Honey has been used on the skin as a dressing after surgery, and some studies suggest it helps wounds heal without becoming infected. It should be used on minor wounds only. 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 are mixed. In one study, aloe seemed to extend the time nneded for surgical wounds 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 2 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 Chamaemelum 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 makes the effects of bromelain stronger. Like bromelain, turmeric may increase the risk of bleeding. If you take blood-thinning medications such as warfarin (Coumadin), clopidogrel (Plavix), or aspirin, ask your doctor before taking turmeric.
• Gotu kola helps the body repair connective tissue and heal wounds, and prevents scars from growing larger. DO NOT take gotu kola if you have high blood pressure or experience anxiety. DO NOT take gotu kola if you have hepatitis or liver disease. Gotu kola may interfere with the way your body metabolizes medications. Talk with your doctor.
• Echinacea and goldenseal (Hydrastis canadensis), used together, may help protect against infection. People with autoimmune diseases, such as lupus or rheumatoid arthritis, should not take echinacea. People with high blood pressure, liver disease, or heart disease should ask their doctor before taking goldenseal. In fact, both of these herbs interact with a number of medicaitons. Speak with your doctor prior to using these herbs if you also take medication.
• Dandelion (Taraxacum officinale) is another herb with anti-inflammatory and antioxidant properties. It may help with wound healing, however, scientific studies are lacking. 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. Dandelion can interact with many other medications, including lithium, so ask your doctor before taking it.
• Pycnogenol (Pinus pinaster), an extract of the bark of a particular type of pine tree, helps promote skin health. People with autoimmune diseases, such as rheumatoid arthritis or lupus, or those who take drugs to suppress their immune systems, should not take pycnogenol.

Homeopathy

Before prescribing a remedy, homeopaths take into account a person's constitutional type, includes 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 to 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
• An overgrowth of scar tissue, called keloid scar tissue
• Gangrene, tissue death that may require amputation
• Bleeding, sepsis, and tetanus (a potentially fatal infection) are other 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 mean an infection.

Supporting Research

Belcaro G, Cesarone MR, Errichi BM, Ledda A, Di Renzo A, Stuard S, et al. Venous ulcers: microcirculatory improvement and faster healing with local use of Pycnogenol. Angiology. 2005 Nov-Dec;56(6):699-705.

Blazso G, Gabor M, Schonlau F, Rohdewald P. Pycnogenol accelerates wound healing and reduces scar formation. Phytother Res. 2004 Jul;18(7):579-81.

Cutting KF. Honey and contemporary wound care: an overview. Ostomy Wound Manage. 2007 Nov;53(11):49-54. Review.

Ermertcan AT, Inan S, Ozturkcan S, Bilac C, Cilaker S. Comparison of the effects of collagenase and extract of Centella asiatica in an experimental model of wound healing: an immunohistochemical and histopathological study. Wound Repair Regen. 2008 Sep-Oct;16(5):674-81.

Jull A, Walker N, Parag V, Molan P, Rodgers A; Honey as Adjuvant Leg Ulcer Therapy trial collaborators. Randomized clinical trial of honey-impregnated dressings for venous leg ulcers. Br J Surg. 2008 Feb;95(2):175-82.

Maeda Y, Loughrey A, Earle JA, Millar BC, Rao JR, Kearns A, et al. Antibacterial activity of honey against community-associated methicillin-resistant Staphylococcus aureus (CA-MRSA). Complement Ther Clin Pract. 2008 May;14(2):77-82.

Reuter J, Merfort I, Schempp CM. Botanicals in dermatology: an evidence-based review. Am J Clin Dermatol. 2010;11(4):247-67.

Rowe DJ, Baker AC. Perioperative risks and benefits of herbal supplements in aesthetic surgery. Aesthet Surg J. 2009 Mar-Apr;29(2):150-7.

Sharp A. Beneficial effects of honey dressings in wound management. Nurs Stand. 2009 Oct 21-27;24(7):66-8, 70, 72 passim. Review.

Stechmiller JK, Childress B, Cowan L. Arginine supplementation and wound healing. Nutr Clin Pract. 2005 Feb;20(1):52-61. Review.

Tepaske R, Velthuis H, Oudemans-van Straaten HM, et al. Effect of preoperative oral immune-enhancing nutritional supplement on patients at high risk of infection after cardiac surgery: a randomised placebo-controlled trial. Lancet. 2001;358:696-701.

Toon CD, Ramamoorthy R, Davidson BR, Gurusamy KS. Early versus delayed dressing removal after primary closure of clean and clean-contaminated surgical wounds. Cochrane Database Syst Rev. 2013;9:CD010259.

Townsend. Sabiston Textbook of Surgery. 19th ed. Philadelphia, PA: Elsevier Saunders; 2012.

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Review Date: 1/5/2015  

Reviewed By: Steven D. Ehrlich, NMD, Solutions Acupuncture, a private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

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