Your Skin and Beyond Part 4

Prevention is the first, last, and best step in wound treatment.

Joy Pape By Joy Pape, RN, BSN, CDE, WOCN, CFCN

We’re still talking wound care. Seems like it’s been a l-o-n-g talk. That’s how it can be with diabetes and wounds. It can take much longer for your wounds to heal. So, I’ll start the treatment section with prevention because prevention is the best treatment for diabetes, skin, and wound problems.

Diabetes and wound care basics consist of:

  • Prevention
  • Inspection
  • Cleansing
  • Treatment
  • Protection
  • Prevention

Prevention

Prevention is the best treatment for wounds in a person who has diabetes. Prevention includes but is not limited to:

  • Managing your blood glucose. Aim for as near normal blood glucose levels as possible. This is your best defense and treatment for wound healing.
  • Foot Care
  • Skin Care

Inspection

  • Look at your wound when you clean and dress (protect) it. If you think you need to look at it more, do so unless your health care provider has told you not to. Look at the wound bed (the surface of your wound) and the peri-wound area (the area around or next to your wound).
  • Report increased redness, warmth, drainage or change in color of drainage, odor, pain, fever, or any changes you are not sure about.
  • Look for and report any swelling or increase in swelling. If you notice a decrease in swelling, that is usually a good sign.

Wound cleansing

  • Wash your hands before cleansing or treating your wound. Even if you wear gloves for your wound care, first wash and dry your hands.
  • Clean your wound with a mild soap and water. Rinse well with water. It is best to use products made especially for wound cleansing or use normal saline, which is a salt-water solution you can get at your pharmacy. Talk with your health care provider (HCP) about the best wound cleanser for your wound. You should cleanse your wound with every dressing change or as directed by your HCP.
  • Note that regular soap, hydrogen peroxide, and povodine iodine products can impair or slow wound healing. Avoid these products to cleanse your wound unless otherwise instructed by your HCP.
  • Pat the peri-wound area dry with a clean cloth or gauze.

Treatment

Wound treatment depends on the type and severity of your wound, your health care professional’s experience, expertise, preferences, your ability to care for your wound, your health care coverage, and the list goes on. Treatment can vary from a Band-aid to very sophisticated wound care programs.

In the third part of our wound care series, I talked about minor and major wounds. We’ll keep our discussion to that.

Minor Wounds

Minor wounds are:

  • superficial – they happen to the outer layer of your skin, the epidermis
  • not near the natural openings of your body (eyes, ears, nose, mouth, urethra, vagina, rectum)
  • not heavy bleeders
  • not larger than the size of a dime, quarter, or silver dollar, and if more, the bleeding can be stopped.
  • wounds that don’t require medical help

When treating minor wounds, be sure blood glucose is normal or near normal levels. Inspect the wound regularly for changes, as noted above. Cleanse the wound and cover it to treat and protect the wounded area.

Things to keep in mind for wound coverings

  • Use dressings to keep wound moist, not wet.
  • Keep area around wound dry.
  • If adhesive (tape) is used, make sure it is tight enough to hold the dressing, but not so tight to cut off circulation to area.
  • Remove tape gently. If the tape is not easy to remove, use a skin adhesive remover you can find in your pharmacy to help loosen the tape. There are also skin preparation products that can be used under the tape that helps make it easy to remove tape.
  • If you have a reaction to tape, use tape especially made for people with tape allergies. There are also wipes you can purchase to protect your skin before you apply tape. Tell your HCP you have a tape allergy.

Samples of dressings for minor wounds consist of but are not limited to:

  • Band aids
  • Over the counter lotions, creams, and ointments
  • Gauze
  • Dressings that keep a wound moist but keep the peri-wound area dry. Examples of these types of dressings are hydrocolloids, transparent film dressings, foam dressings, and more.

Major Wounds

For the purpose of this article, major wounds are defined as wounds that are considered severe, not always life threatening, but that require being seen by a health care provider. Some major wounds start out as minor wounds that do not heal. This is often the case in people who have diabetes. Let’s also consider pressure ulcers to be major wounds.

Treatment for major wounds includes but is not limited to the same principles as the treatment for minor wounds. What is different is that treatment will include seeing a health care professional and following your prescribed regimen which will start with diagnosing the type and severity of your wound. Depending on the place of your wound, this may include an X-ray or MRI to see if there is damage to the inner layers of your skin, your muscles, or bones.

Once diagnosed treatment may consist of:

  • Insulin, if you do not normally take insulin. If you take insulin, you may need to adjust your dose to make sure your blood glucose is normal or near normal.
  • Antibiotics by mouth, injections, or intravenous (IV)
  • Off-loading – getting the pressure off and keeping it off the wound. This may include wearing a cast, bed rest, special mattresses, special shoes, and more.
  • Specialized dressings such as those mentioned above, but also more advanced wound dressings such as: silver dressings, pain reducing dressings, collagen, growth factors, and more.
  • Treatments such as hyperbaric oxygen, vacuum dressing therapies, and more.

Protection

Treatment consists of protecting your wound. Treatments are designed to protect wounds from bacteria, drying out or too much moisture, extremes of temperature, pressure, friction, and more.

Prevention

Treatment also consists of preventing further damage to your wound. Some treatments are also aimed at improving your nerve function and circulatory status to prevent you from further skin damage. Once again, your best prevention even if you already have a wound, is managing your blood glucose to normal or near normal levels.

So, we see, just like diabetes care, wound care is not simple. If you have any more than a minor wound that is healing, it is important for you to see your health care provider right away. Get treatment as soon as possible to heal your wound and live a l-o-n-g healthy life rather than have a wound that takes a l-o-n-g time to heal.

EnJOY!

Read Joy’s bio here.

Read more of Joy Pape's columns.

NOTE: The information is not intended to be a replacement or substitute for consultation with a qualified medical professional or for professional medical advice related to diabetes or another medical condition. Please contact your physician or medical professional with any questions and concerns about your medical condition.

PREVIOUS: Your Skin and Beyond - Part 3

Last Modified Date: November 28, 2012

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