Schiffert Health Center: Wound Care 101

Schiffert Health Center
www.healthcenter.vt.edu
Patient Information:
Wound Care 101:

Soft tissue injuries (cuts, abrasions, blisters,
burns, and bruises) are common occurrences for the
college student. At Schiffert Health Center we see
minor to major wounds (from blisters on feet due to ill
-fitting shoes to severe abrasions and lacerations from
accidents). For the untrained, management of these
injury at home may be intimidating and confusing
with the wealth of information coming from friends,
parents, and the Internet. I just let it scab over or
I put Neosporin on it are common student methods,
but may not be appropriate for the best wound
healing.
BRIEF ANATOMY OF THE SKIN

There are three layers of the skin that are
commonly injured by the students when they suffer
cuts, burns, abrasions, blunt trauma, and surgical
wounds.
The outermost layer, about .1mm to 1.5
mm thick depending on the body location; composed
of 5 layers of epithelial cells; no blood vessels
present; most cells of this layer are actually dead,
dried and hardened.
D
. Supports and nourishes the epidermis;
protects against injury, infection, and regulates
temperature; is rich with blood small blood vessels,
nerves, sebaceous glands, sweat glands, and hair
follicles. Its architecture is supported by proteins
called collagen and elastin.
This layer is the connective tissue
under the dermis; binds skin loosely to underlying
tissue (e.g. fasciae, muscle, bone, etc); cushions
underlying structures; contains lymphatics and deep
blood vessel supply; channels oxygen and nutrients to
the dermis via capillaries.
Below the subcutaneous layer there are other
deeper tissues variably found in the human body
(fascia, muscle, bone, ligaments, tendons, cartilage,
nerves, and blood vessels) but these wont be
described further.
STOP THE BLEEDING
After sustaining a wound, the first priority is to

control bleeding (if present), usually with direct
Copyright Schiffert Health Center

Revised January 2016
pressure with a finger, hand, or firmly wrapped towel,

etc. Fortunately, most acute wounds dont bleed for
long, thanks to the natural clotting abilities of the
human body. Bleeding wounds not controlled by
pressure are a medical emergency, call 911 or go to
the ER.
CLEAN THE WOUND

When the bleeding (if present) has stopped or
slowed to merely oozing, cleaning the wound is
appropriate*:
Rinsing the wound in normal saline is best but not
super convenient (2 tsp of salt to 1 liter of boiled

water). Tap water is acceptable. Use water at
room temperature or warmer.
Immersing the hand and swishing it around in a
bowl of water, or running tap water over the

wound for several minutes is fine (safe irrigation
pressures are 4-15 PSI). Higher water pressure
will drive bacteria and debris deep into the tissue.
Hydrogen peroxide provides an effervescent
cleansing action, but has very limited

antimicrobial activity and should be considered
only if a wound is fresh and contaminated (with
dirt, etc.). It is otherwise damaging to healthy
tissue cells.
Dont use alcohol, it burns, it harms healthy
tissueenough said.
Scrubbing the tissue may not be possible with a
fresh wound for some (due to pain); but using

soft, non-abrasive gauze from the center of the
wound outward to the wound edges is best; dont
reintroduce gauze that has touched the outside of
you skin into a fresh wound!
In the subsequent days after your initial wound,
showering is fine, gentle washing and letting the

soapy water run over and down the wound area is
fine.* Do not soak the wound unless instructed to
do so.
*This assumes this is not a surgical wound, a wound

that is covered with specialized dressings, or a wound
under SHC Wound Care Clinic care.
McComas Hall 540-231-6444

[email protected]
Wound Care 101:
DRESS THE WOUND
This is most important with severe or infected

wounds. This is most beneficial during the first 24-48
hours, but serious wounds and/or infected ones may
benefit from longer periods. You may take what ever
over-the counter medications (such as Tylenol or
ibuprofen) you usually take for discomfort or pain.
Follow the directions in the bottle.
The wound should be kept from drying out

(scabbing), and covered. Dont allow a wound to
crust and scab over! A moist (not soggy and wet)
wound bed allows for migration of cells across the
wound more rapidly thus the wound heals more
quickly and scarring is reduced.
When body tissues have been damaged by cuts,
burns, blisters, or abrasions, the wounds should be
protected and watched for infection until healing has
taken place. Acceptable products to place over the
open wound include:
Plain petroleum jelly,
SIGNS OF INFECTION
Wound infection means invasion of pathologic
organisms into healthy tissue to the extent that they
overwhelm your bodys immune response. It results
in one or more of the following reactions:
A&D Ointment
Bacitracin, or generic triple-antibiotic ointment
Calmoseptine Ointment.
Apply these to the wound with a cotton swab, or

clean finger with each dressing change.
Once you have applied a moisturizing product,

cover the wound with a dressing such as a 2X2 or
4x4 gauze, secured with first-aid tape or cottongauze wrap. Large Band-Aids or other non-adhesive
dressings (with built in tape) are fine. If buying
gauze, purchase a type with a non-adherent coating.
It will prevent it from sticking to a wound. If you are
having trouble determining how to dress or protect a
wound, call SHC to make a consultation appointment
with a practitioner.
This may limit your activity to some extent. If
necessary, bandages on fingers and hands may be
covered with a rubber glove or a plastic bag to
prevent the dressed wound(s) from getting wet at
work, at play, or in the shower. Do not submerge
dressed wounds in water from pools, hot tubs, or the
New River. While moist wound is good, a soggylooking, pale, and wrinkling wound indicates too
much moisture.
If the bandage becomes loose, wet, dirty, or blood
seeps through the dressing, it will need to be
changed. Typically, for minor wounds with over-thecounter dressings, changes are done every 24 hours.
By holding and/or propping up the wound at or

above the level of the heart you can help reduce pain
and swelling* which will improve the healing process.
Page 2 of 3
*Prolonged pain and swelling, especially after an

interval of improvement is suggestive of infection,
especially when associated with several other SIGNS
OF INFECTION (see below).
Swelling or firmness of tissue surrounding the
wound
Tenderness (increasing pain in the wound area)
Redness of the wound, the wound margins or
surrounding skin
Heat or warmth greater than nearby normal skin
Unexplained fever
Other than small amount of clear drainage from
the wound site (large amounts of clear, cloudy or

yellow discharge)
Foul odor
Wound color change from beefy-red to yellow,
brown, grey, or pale.

New tissue breakdown (e.g. wound getting larger)
Call the Schiffert Health Center if any of the above

is apparent as a SHC practitioner may prescribe
special wound care, topical or oral antibiotics for the
condition.
The wound should be protected from repeated
injury, chaffing, rubbing, or drying out until it is
healed. If you are having trouble determining how to
dress or protect a wound, call SHC to make a
consultation appointment with a practitioner.
Wound healing times are variable, and depend on
depth, wound care, patient health, and wound care
compliance. For most wounds, when a smooth, fresh,
dry, non-tender layer of skin has covered the injury
site the first phases of wound healing are complete.
Copyright Schiffert Health CenterRevised January 2016
Wound Care 101:
No further dressings are needed, if only to protect the

site from recurrent injury or to further try to reduce
scarring.
A partial thickness wound (such as a deep paper
cut) may go through its obvious healing phases in 4-7
days. A full-thickness laceration on the knee may
take 2-3 weeks to heal-over with a red or pink area
being present for weeks. It is called postinflammatory hyper-pigmentation and is normal to
see. The toughness or tensile strength of the skin
may take a month to 2 years to achieve normal skin
strength.
SCARRING
Make an appointment with a SHC practitioner to

discuss your wound if:
You have two or more SIGNS OF INFECTION as
noted above.
You have been directed to follow up by an outside
provider (e.g. surgeon, ER physician, primary care

physician).
You have been dressing your wound yourself, but
are developing a rash from ointments or tapes, or

the wound keeps recurring.
If you have concerns about your ability to care for
Most wounds caused by crushing, tearing, ripping

or abrasion have tissue damage surrounding the
actual wound. This increases the amount of scar
tissue. Scabbing increases scarring and increases the
risk of infection, which if present, will also increase
the amount of scar tissue formed. Scars are natural
results of the body repairing itself and remodeling the
new tissue to take over the old damaged, or lost
tissue. The scar will take several months to resolve
(regretfully, some will remain permanently). Scarring
is influenced by:
Mechanism of injury
Depth of wound.
your wound yourself.

Your wound is a burn that has blistered an area as
large as the palm of your hand on any part of the

body, is on the face, eyes, or ears), is on the
hands, feet or is completely around a joint or
extremity, or is on the groin.
You have a laceration that wont hold together
with out help from pinching skin or adhesives, or

that wont stop bleeding, or that is associated with
loss of sensation or strength. Most lacerations
should be sutured within 6-12 hours of occurring,
but this varies on body location and circumstances
of the injury.
You have a wound from a cat, dog, or other
Wound care (e.g. scabbing vs. moist wound
animal bite (even a human) that shows SIGNS OF

INFECTION.
healing)
Mechanical means to close the wound (e.g.
sutures, staples, tapes, glue)

Infection present initially or as a complication of
healing
WOUND DRESSING INSTRUCTIONS:

1. Change dressing ___ time(s) every ____ day(s).
2. Clean the wound before each dressing change with
warm water. Gently wipe/rub the wound with
clean wash cloth only to clean loose crusts, dirt or
debris.
Re-injury of site while in healing process

Location of the injury
Pigment of skin
Traction forces on the skin at the site of injury.
There are over-the-counter scar treatments that

you can apply topically. Mederma and Neosporin
Scar Treatment are two of many over-the-counter
scar reducing products. There are others, most
lacking clinical studies to prove effectiveness. If you
are concerned about the scar's appearance, or there
is decreased flexibility at the wound site (e.g. a joint),
contact Schiffert Health Center and have a
practitioner take a look at it.
Page 3 of 3
WHEN TO CONTACT SHC FOR WOUND CARE
3. Apply ______________________ topically over

the wound bed of the burn, abrasion, blister, or cut
to keep it moist, reduce infection risk, and promote
healing. Replace after each wound cleansing.
4. Primary dressing: Apply ___________________
over the wound bed topical treatment (if any).
5. Secondary dressing: Apply ________________
over the primary dressing to protect wound,
dressing, and to keep it secure.
6. Return for wound check (in ___ days / as needed).
Other instructions:
__________________________________________________
Copyright Schiffert Health CenterRevised January 2016

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Schiffert Health Center

Wound Care 101:

BRIEF ANATOMY OF THE SKIN

STOP THE BLEEDING

After sustaining a wound, the first priority is to

Copyright Schiffert Health Center

pressure with a finger, hand, or firmly wrapped towel,

CLEAN THE WOUND

super convenient (2 tsp of salt to 1 liter of boiled

Immersing the hand and swishing it around in a

bowl of water, or running tap water over the

Hydrogen peroxide provides an effervescent

cleansing action, but has very limited

Dont use alcohol, it burns, it harms healthy

fresh wound for some (due to pain); but using

In the subsequent days after your initial wound,

showering is fine, gentle washing and letting the

*This assumes this is not a surgical wound, a wound

McComas Hall 540-231-6444

Wound Care 101:

DRESS THE WOUND

This is most important with severe or infected

The wound should be kept from drying out

Apply these to the wound with a cotton swab, or

Once you have applied a moisturizing product,

By holding and/or propping up the wound at or

*Prolonged pain and swelling, especially after an

Swelling or firmness of tissue surrounding the

the wound site (large amounts of clear, cloudy or

brown, grey, or pale.

Call the Schiffert Health Center if any of the above

Copyright Schiffert Health CenterRevised January 2016

Wound Care 101:

No further dressings are needed, if only to protect the

Make an appointment with a SHC practitioner to

provider (e.g. surgeon, ER physician, primary care

You have been dressing your wound yourself, but

are developing a rash from ointments or tapes, or

If you have concerns about your ability to care for

Most wounds caused by crushing, tearing, ripping

your wound yourself.

large as the palm of your hand on any part of the

You have a laceration that wont hold together

with out help from pinching skin or adhesives, or

You have a wound from a cat, dog, or other

Wound care (e.g. scabbing vs. moist wound

animal bite (even a human) that shows SIGNS OF

sutures, staples, tapes, glue)

WOUND DRESSING INSTRUCTIONS:

Re-injury of site while in healing process

Traction forces on the skin at the site of injury.

There are over-the-counter scar treatments that

WHEN TO CONTACT SHC FOR WOUND CARE

3. Apply ______________________ topically over

Copyright Schiffert Health CenterRevised January 2016

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