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Wounds

• Signs and Symptoms
• What Causes It?
• Who's Most At Risk?
• What to Expect at Your Provider's Office
• Treatment Options
• Prognosis and Possible Complications
• Following Up
• Supporting Research

A wound is a break in the structure of an organ or tissue caused by something outside the body. Most wounds affect the skin, the first line of defense against infection. Common examples include bruises, grazes, tears, cuts, punctures (made by pointed objects), incisions (clean cuts), contusions (may not break the skin but can cause damage), lacerations (jagged, irregular cuts), and burns. While most minor wounds heal easily, some can worsen into chronic open sores that can become seriously infected.

Signs and Symptoms

Wounds are often accompanied by the following signs and symptoms:

• Bleeding
• Redness
• Swelling
• Pain and tenderness
• Heat
• Possible fever with infection
• Loss of function (or mobility)
• Oozing pus, foul smell (in infected wounds only)

What Causes It?

Wounds can be caused by any of the following:

• Blunt or penetrating trauma
• Surgery
• Chemical injury
• Thermal injury
• Temperature extremes (for example, burns or frostbite)
• Radiation

Who's Most At Risk?

The following risk factors are associated with wounds:

• Age (older people are at higher risk)
• Malnourishment, especially protein depletion
• Trace element deficiencies, especially zinc
• Vitamin deficiencies, especially vitamin C
• Compromised general health
• Steroid use
• Radiation and chemotherapy
• Diabetes
• Smoking
• Weight loss or obesity

What to Expect at Your Provider's Office

If you receive a serious wound, you should see your health care provider. Your health care provider will determine the extent and severity of the injury, possible contamination, and conditions that might complicate treatment. Your health care provider may also order laboratory tests, such as a blood test and urinalysis, as well as a culture to check for bacteria in the wound. They may also suggest you get a tetanus shot or a tetanus booster.

Treatment Options

Prevention

Most wounds are accidental and often preventable. Once you've received a wound, you can prevent infection and other complications by carefully cleaning the wound and using antibiotics as needed.

Treatment Plan

Treatment depends on the type and severity of the wound. Some wounds, such as clean lacerations, are relatively minor and can be treated at home. Clean the wound with water, and stop the bleeding by applying gentle pressure. Apply an antibiotic cream, then cover the woond with an adhesive bandage.

Other wounds -- particularly those in which the bleeding will not stop, deep cuts that show muscle or fat, or animal or human bites or fishhook injuries (do not remove the hook) -- can be serious. You must see a health care professional for treatment.

Some wounds may involve a loss of tissue and require a skin graft, where a piece of skin is cut from a healthy part of the body and used to heal the damaged area.

Your health care provider will determine whether the wound can be closed immediately, by suturing or grafting, or whether it must be kept open because of contamination. Infected wounds are never closed until the wound has been successfully treated.

Drug Therapies

Your heatlh care provider may prescribe the following medications:

• Analgesics, or pain relievers
• Antiseptics, to clean contaminated wounds
• Antibiotics for infections or sepsis (destruction of tissues by disease-causing bacteria, accompanied by a strong odor)
• Medicated dressings
• Corticosteroid hormones
• Tetanus shots

Surgical and Other Procedures

Surgery is sometimes needed for severe wounds. This may involve cutting away burned tissue and removing contaminated tissue, skin grafting, and draining wound abscesses (pus surrounded by inflamed tissue).

Complementary and Alternative Therapies

You can use complementary and alternative therapies for minor household injuries or after more serious injuries have already received thorough medical attention. If you have doubt whether or not your wound is serious, do not use alternative therapies before speaking with your doctor. Never apply topical remedies to any open wound without a doctor’s supervision.

Nutrition

Potentially beneficial nutrient supplements include those listed below. These supplements can also be taken before surgery to reduce healing time. Lower dose or stop use when your wound has healed.

• Beta-carotene (250,000 IU a day) or vitamin A (25,000 IU a day) to promote healthy scar tissue. These are high doses, and you should not take them for longer than 1 - 2 weeks without your health care provider's supervision. Reduce dose to 50,000 IU of beta-carotene and 15,000 - 25,000 IU of vitamin A daily after 2 weeks. Do not take high doses of vitamin A if you are pregnant, trying to conceive, or have liver disease.
• Vitamin C (1,000 mg two to six times per day) helps skin heal by enhancing tissue formation and strength. Lower dose if diarrhea develops.
• Vitamin E (400 - 800 IU a day) promotes healing. May be used externally once the acute phase has passed and new skin has formed. Higher doses may be beneficial for healing burns.
• Zinc (10 - 30 mg a day) stimulates wound healing. You can also apply zinc topically in a cream to speed wound healing. Do not apply to open wounds.
• B complex vitamins (1,000 mcg per day), including B1 (thiamine) and B5 (pantothenic acid), may aid wound healing and skin health.
• Bromelain (40 mg four times a day between meals) reduces post-surgical swelling, bruising, healing time, and pain.
• Glucosamine (1,500 per day in divided doses) and chondroitin sulfate (400 mg two times per day) may help heal wounds by encouraging the repair of connective tissue in the body, but studies are needed to confirm the effect.
• L-arginine (17 - 25 g per day) has been used to improve healing time in surgery patients. Use caution if you are prone to herpes outbreaks, and talk to your doctor.
• Whey protein, taken as a daily protein shake, provides essential amino acids for wound healing and tissue repair.

Herbs

Certain herbal remedies may offer relief from symptoms and help wounds heal faster. Herbs are generally available as dried extracts (pills, capsules, or tablets), teas, or tinctures (alcohol extraction, unless otherwise noted). People with a history of alcoholism should not take tinctures. Dose for teas is 1 heaping tsp. per cup of water steeped for 10 minutes (roots need 20 minutes), unless otherwise noted.

Applied topically

Never apply herbs to open wounds unless under a doctor's supervision.

• Aloe (Aloe vera), as a cream or gel
• Calendula ( Calendula officinalis ), or marigold, as an ointment or a tea applied topically. To make tea from tincture, use 1/2 to 1 tsp. diluted in 1/4 cup water. You can also steep 1 tsp. of flowers in one cup of boiling water for 15 minutes, then strain and cool. Test skin first for any allergic reaction.
• Marshmallow ( Althaea officinalis ) as a topical ointment to help wounds heal and fight inflammation.
• Tea tree oil ( Melaleuca alternifolia ) as oil or cream. Apply two times per day to reduce inflammation. Do not use tea tree oil to treat burns.
• Horsetail (Equisetum arvense) as a cream or ointment, to speed wound healing and lessen inflammation.
• Gotu kola ( Centella asiatica ) as a cream containing 1% of the herb, to help heal wounds.
• Echinacea or coneflower ( Echinacea angustifolia or purpurea ) as a gel or ointment containing 15% of the juice of the herb.
• Slippery elm bark ( Ulmus rubra or fulva ) as a poultice. Mix 1 tsp. dried powder in one of cup of boiling water. Cool and apply to a clean, soft cloth. Place on affected area.

Taken orally

• Turmeric ( Curcuma longa) is an anti-inflammatory that increases the effects of bromelain. Use dried extract 250 - 500 mg three times a day.
• Gotu kola promotes connective tissue repair, supports normal wound healing, and prevents a scar from growing larger. Use standardized extract 60 mg one to two times daily, or 60 drops of tincture three to four times per day. Do not take gotu kola if you have high blood pressure or experience anxiety.
• Coneflower and goldenseal ( Hydrastis canadensis ), used together, protect against infection. Use equal parts tincture 30 - 60 drops three to four times a day.
• Horsetail (300 mg three times per day). Horsetail is a diuretic. Do not take horsetail if you have kidney disease or heart disease, or if you take a prescription diuretic (water pills).
• Burdock ( Arctium lappa , 2 - 6 g per day) is an anti-inflammatory and antioxidant. Do not take burdock if you have diabetes, take blood-thinning medication, or take a diuretic (water pills).
• Dandelion ( Taraxacum officinale , 2 - 8 g per day) is another herb with anti-inflammatory and antioxidant properties. Be sure you do not have an allergy to dandelion, and avoid taking the herb if you have liver or gallbladder disease, diabetes, or kidney disease, or if you take blood-thinning medication.
• Pycnogenol ( Pinus pinaster , 200 mg per day), an extract of the bark of a particular type of pine tree, helps promote skin health.

Homeopathy

Some of the most common acute remedies for wounds are:

• Arnica -- for bruised feeling and grief or shock from trauma. It should be taken immediately after injury and repeated several times throughout the day for 1 - 2 days after injury.
• Calendula -- for wounds where the skin is broken but there are no other symptoms
• Staphysagria -- for pain from lacerations or surgical incisions
• Symphytum -- for wounds which penetrate to the bone
• Ledum -- for puncture wounds
• Urtica -- for burns
• Hypericum -- for injuries and trauma to nerves
• Wala -- for keloids

Prognosis and Possible Complications

Prognosis depends on the extent and severity of the initial wound, as well as any subsequent infection. There are several complications associated with wounds: infection, keloid scar tissue formation (an overgrowth of scar tissue that can be deforming), and gangrene (which may require amputation). Wound hemorrhage, sepsis, and tetanus (a potentially fatal infection of the nervous system) are also complications that can arise from wounds.

Following Up

Check for signs of bleeding, discoloration, or swelling in and around the wound. Tell your health care provider if you have fever, increasing pain, or develop drainage, which may indicate an infection.

Supporting Research

Black JM, Matassarin-Jacobs E. Medical-Surgical Nursing: Clinical Management for Continuity of Care . 5th ed. Philadelphia, Pa: W.B. Saunders Co; 1997.

Blumenthal M, ed. The Complete German Commission E Monographs . Boston, Mass: Integrative Medicine Communications; 1998:432.

Carr AC, Frei B. Toward a new recommended dietary allowance for vitamin C based on antioxidant and health effects in humans. Am J Clin Nutr. 1999;69(6):1086-1107.

Johnston CS. Recommendations for vitamin C intake. JAMA. 1999;282(22):2118-2119.

Kirk SJ, Hurson M, Regan MC, et al. Arginine stimulates wound healing and immune function in elderly human beings. Surgery. 1993;114:155–60.

Kruzel T. The Homeopathic Emergency Guide . Berkeley, Calif: North Atlantic Books; 1992:312, 314, 316.

Levine M, Rumsey SC, Daruwala R, Park JB, Wang Y. Criteria and recommendations for vitamin C intake. JAMA. 1999;281(15):1415-1453.

Liszewski RF. The effect of zinc on wound healing: a collective review. J Am Osteopath Assoc. 1981;81:104–6

Mazzotta MY. Nutrition and wound healing. J Am Podiatr Med Assoc. 1994;84:456–62.

McCarty MF. Glucosamine for wound healing. Med Hypotheses. 1996;47:273–5.

Reeves CJ, et al. Medical-Surgical Nursing . New York, NY: McGraw-Hill; 1999:535, 542-546, 551-553, 567-568.

Shukla A, Rasik AM, Jain GK, et al. In vitro and in vivo wound healing activity of asiaticoside isolated from Centella asiatica. J Ethnopharmacol. 1999;65:1–11.

Tepaske R, Velthuis H, Oudemans-van Straaten HM, et al. Effect of preoperative oral immune-enhancing nutritional supplement on patients at high risk of infection after cardiac surgery: a randomised placebo-controlled trial. Lancet . 2001;358:696-701.

Thompson JM, et al. Mosby's Clinical Nursing . 4th ed. St. Louis, Mo: Mosby; 1997:461-462, 1099-1100, 1160, 1441

Vaxman F, Olender S, Lambert A, et al. Can the wound healing process be improved by vitamin supplementation? Experimental study on humans. Eur Surg Res. 1996;28:306–14.

• Review Date: 10/17/2006
• Reviewed By: Steven D. Ehrlich, N.M.D., private practice specializing in complementary and alternative medicine, Phoenix, AZ. Review provided by VeriMed Healthcare Network.

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