So you just tripped over a soccer shoe and banged your knee on the coffee table. It’s bleeding and it hurts and there will be a conversation in the near future about where we put our soccer shoes. At the same time, your instincts are telling you this mishap does not merit professional attention in a clinical sense.
What comes next? How can we be sure this wound will heal efficiently and completely? How do you know when it warrants a visit to a walk-in clinic, your primary provider or virtual care visit?
A wound is defined as a break in the skin or in other tissues. It can be a cut, a scratch, or punctured skin. Wounds are usually not serious but you can help yourself and your family a bunch by knowing some of the diagnostic and treatment basics.
“I think a lot of the acute wounds can be treated at home — we’re talking about minor scrapes, skin tears and bug bites that include penetrating trauma,” said Rosa Eyton, a nurse practitioner and wound care specialist at Sanford Aberdeen Clinic. “When I think about a wound needing to be seen by a provider, I think about wounds that are really painful or wounds that are infected.”
Keep wounds clean and covered
The foundation of treating a wound at home is built on cleanliness. Make sure the wound is clean and make sure it stays clean. Preventing infection is the first priority regardless of the bandaging product used.
Most often Eyton advises cleaning wounds with a saline solution or a mild soap that is fragrance-free and will be less irritating on the skin. It can vary depending on severity, of course.
Antiseptics like Betadine are good because they will kill or prevent bacteria from growing that may be present, especially in deep and dirty cuts. Prolonged use, however, can slow healing because it will eventually start killing off good tissue, too. After a few days, saline or a mild soap is a better option.
“If I’m really worried about infection at home there are some antiseptics sold over the counter that I would use,” Eyton said. “An example would be a topical antiseptic like Betadine or a chlorhexidine (common brands: Betasept, Hibiclens) or a sodium hypochlorite (common brand: Dakin’s). Those are all three versions of diluted antiseptics that are safe, over-the-counter products that in the short term can help clean up a dirty wound for up to a week.”
There remains a persistent belief that letting a wound dry out will speed up the process. Research shows that keeping a wound moist and clean can speed up healing time by as much as a week, however.
You can do this with help from an over-the-counter topical antibiotic like Neosporin, or with a petroleum jelly like Vaseline. Vaseline is not an antibiotic but can act as a barrier to bacteria while also preventing a cut or scrape from drying out.
“A lot of people grow up believing you have to let a wound dry out,” Eyton said. “But wound healing is really like growing a garden. You have to find that balance. You don’t want it too dry or too wet if you’re trying to grow good vegetables.”
How fast wounds should heal
Wounds come in two categories, Eyton said. There are acute wounds caused by trauma — banging your knee on the coffee table, for instance — but there are also chronic wounds that don’t go away.
Acute deeper wounds or wounds that cover a lot of skin will take longer to heal. In many instances, any acute wound not improving after two to four weeks could be an indication of a chronic wound. If that’s a possibility, care providers like Eyton will often investigate other causes. Chronic wounds can be a symptom of serious issues involving nutrition, smoking, disease or a medication.
“If you’re not seeing real healing after two to four weeks, it’s probably time to get more information about why it’s not healing,” Eyton said. “A big part of my role as a wound specialist is helping collaborate with other specialists who might be involved with some of our more complex patients.”
Those who have existing health issues may not heal as quickly. If you’re diabetic or are dealing with cancer or cancer treatments, for instance, it can increase the risk of wounds not healing. In those cases, Eyton will dig into the individuals’ health history and optimize a wound-healing plan.
The good news is that if you keep a cut or scrape clean, most often your body takes care of the healing. For the committed home-healer, preventing infection and identifying it when it’s present will always be most important.
“If there’s redness around the wound or more drainage than your typical Band-Aid or over-the-counter dressing can manage, it’s time to get some more help,” Eyton said. “If the pain is getting worse instead of better, or there was no pain yesterday and now it’s hurting really bad, that can be a sign of infection.”
When to get care from a doctor
Sometimes, as Eyton suggests, “it’s time to get some more help.” A wound might need more attention than you can give it. It could be a wound that is deeper than you can tend to on your own or a wound that is not healing as it should. In those cases, Sanford has several options available:
- Walk-in to get urgent care: For cleaning and tending to a wound that is questionably infected without visible bone or tendon. It could involve sutures and/or antibiotics as appropriate, or if you have an open wound and a fever.
- E-visit: Appropriate for wounds with no signs of infection and are not responding to home care. During an e-visit, the patient can seek additional guidance or referral to a specialty provider. An e-visit is also appropriate for minor rashes or smaller scrapes and cuts when you can’t get in to see your primary care provider. During an e-visit, they will often direct you to the next best place.
- Primary care provider: A visit to your primary care provider is appropriate for a referral to see a wound specialist and general guidance on wound care — similar to an e-visit.
- Emergency care: For wounds where the bleeding continues after pressure has been applied for 10 minutes, or you can’t feel or move the injured spot, and for deeper wounds (seeing muscles, bones or tendons); wounds caused by an animal; wounds located on the face or near a bone; wounds caused by something rusty.
- Chronic wounds, specialized care: Focus on long-term healing
- Emergency vs urgent care: The ER isn’t for everything
- Stop the Bleed: Making bleeding control as common as CPR