The Role of Skin Care in Wound Management
Preventative skincare is an essential yet overlooked aspect of wound care and scar prevention. It is the usual practice for clinicians to concentrate most of their efforts on closing the wound and managing infections, even though wound contraction and remodeling may continue for up to a year following injury. In full-thickness wounds, scar formation is a natural consequence of the healing process; however, their unaesthetic appearance is a frequent source of unease for patients.
Factors that may contribute to skin damage and scarring include the patient's age, ethnicity, degree of trauma, infection, skin disease (e.g., epidermolysis bullosa contributing to skin fragility), and exposure to radiation (e.g., ultraviolet radiation from sunlight). Skincare helps to prevent further damage and contamination of the skin. A proper skincare regimen not only aids faster healing but may also minimize the appearance of scars after wound closure.
Benefits of Preventative Skincare for Chronic Wounds
Wound healing is a complex series of biological events, from inflammation to proliferation and remodeling. Inflammation, the body's innate response to trauma, occurs soon after injury and causes swelling, redness, pain or heat, followed by the formation of platelets. The second phase involves the proliferation of fibroblasts and endothelial cells, formation of granulation tissues, and angiogenesis. During the remodeling phase, the wound has fully closed up, and affected dermal tissues experience rapid reformation to restore initial tensile strength. Chronic wounds, however, linger in the inflammatory phase and exhibit delayed re-epithelialization. Delayed healing also increases the risk of infection which may contribute to scar formation after healing.
Pressure ulcers develop as a result of prolonged pressure or repetitive friction on the skin. Patients placed on bed rest at healthcare facilities may develop ulcers on pressure points on the skin (bony prominences, such as the ankles, tailbone, and hips) over time due to reduced mobility. Pressure ulcers compromise the affected skin in several ways, including causing discoloration and scars. In addition to frequently repositioning the patient, a regular, preventative skincare regimen can prevent further skin damage. Skincare ensures proper hydration required for optimal wound healing.
Patients living with diabetes are prone to developing wounds on the lower extremities that heal slowly. According to the American Podiatric Medical Association (APMA), diabetic foot ulcers occur in up to 15% of diabetics in the U.S. and is a leading cause of lower-limb amputations. Up to 25% of all diabetic patients with foot ulcers go on to require an amputation. Patients living with diabetes for many years may also develop neuropathy resulting in a loss of sensation in the feet due to increased blood glucose levels. Preventative skin care can help reduce the likelihood of infections, provide an optimal wound healing environment, and reduce scarring at the wound site post-healing.
Venous insufficiency is a leading cause (70 - 90% of cases) of foot ulcers. They result from the malfunction of venous valves, causing pressure to increase in the veins. Since these constricted vessels are responsible for transporting deoxygenated blood to the heart, hypoxia and edema occur due to inadequate circulation. Venous ulcers may compromise the skin by causing stasis dermatitis, which results in scaling and erythema. Ensuring proper maintenance of periwound skin can significantly impact the rate of healing in patients.
Preventative Skincare for Chronic Wounds
Developing a preventative skincare routine for patients in long-term care facilities can help prevent or mitigate symptoms of chronic wounds, such as pressure ulcers, diabetic foot ulcers, and venous insufficiency ulcers. The following are the main components of a proper skincare regimen:
Sanitizing the wound bed and periwound skin with a mild, antibacterial fluid removes dirt and debris that may slow healing. Gauze impregnated with saline solution or medical wipes is suitable for cleaning open wounds. Cleaning also prevents moisture-associated skin damage (MASD) due to sweat, urine, exudate, etc.
For patients with chronic ulcers, using a moisturizing agent like petroleum jelly can help prevent scaling and skin irritation. Moisturizing improves hydration, thus lowering the risk of breakage in sensitive skin, such as skin containing stasis dermatitis. Other scar prevention methods include applying silicone sheets, gels, or other emollients with hydrating properties.
Applying sunscreen to a wound site post-healing reduces the appearance of scars or blotching. The American Academy of Dermatology (AAD) recommends using a broad-spectrum sunscreen containing SPF 30 or higher for regular protection.
Applying and frequently changing wound dressings can improve healing outcomes and prevent MASD due to the accumulation of drainage. Proper choice of dressing depends on the cause of the wound, condition of periwound skin, amount of drainage, and the location of the wound. Dressings should provide sufficient absorption for exudate without desiccation.