Wound Care Can Make All The Difference

Posted on Wed., September 30, 2008
By Stephen Daniels, MD

WHEN INSPECTING JOHN´S feet in my office one afternoon, I noticed what appeared to be the head of a Phillips-head metal screw on the surface of his heel. John, an overweight diabetic, had walked in smiling, wearing slippers.

The 1-inch screw imbedded in his heel - that John couldn´t feel because his diabetes had caused his feet to be numb - became so infected that eventually John needed amputation of his foot.

John´s wound improved when he was in the hospital, but always worsened when he went home. Despite many educational sessions, John didn´t believe that he could help his wound heal.

Most of us recall being cut as children, and observing that wounds seemed to heal almost no matter what we did. But as we age or become chronically ill, getting wounds to heal often requires more effort.

The secrets to good wound healing are:

Improve blood flow to the wound
control infection

Blood flow to the wound can be maximized by a number of actions.

Heat: Heating an area of the body improves blood flow, so apply heat to the wound by putting the wounded area in a bowl (or bucket) of warm water, applying warm, moist towels, or by putting a heating pad turned to low on and around the wound, overlying a moist towel. Generally 15-30 minutes three-to-four times a day is appropriate.
Reduce swelling: Swollen tissue tends to compress the small blood capillaries (tiny blood vessels or tubes that carry blood into the body's tissues) so blood can't get to the wound.

The simplest way to decrease tissue swelling around the wound is to elevate the wound. If the wound is on the foot or leg, the patients should lie down and elevate the wound well above the level of the heart. If the wound is on the buttock, the person should lie face down.

The most common mistake I've seen patients make is to sit with the wounded foot on a stool or ottoman. That position often kinks the blood vessels in the hip, reducing blood flow and increasing swelling, and doesn't elevate the wound enough.

The patient must lie down - almost flat, and elevate the leg so he or she is looking up at the wound.

Generally, elevation should be done for another 15-30 minutes three-to-four times a day, right after the application of moist warmth, or while applying the heat.

Muscles: Gently and periodically use the muscles around the wound. Muscle contractions act as a pump to help blood flow. So, persons with wounds on the foot should walk briefly three-to-four times a day, but avoid putting pressure on the wound itself.

So, for leg or foot wounds, maximize lying down (with wound elevation) and walking (with limitations), and minimize sitting and standing because these worsen swelling.

The second part of wound care is to minimize infection.

Put simply, gently wash the wound with soap and water, apply an antibiotic ointment, and cover the wound to keep out germs, usually twice a day, unless your doctor instructs you differently.

If the wound does not improve, or if you have diabetes or a history of poor wound healing, consult your doctor or a wound care specialist.

Dr. Daniels practices family medicine for the Contra Costa Health Services, the county health department.