Introduction:

A wound is a break in the skin, the first line of defense against infection. Minor wounds include cuts, scrapes (abrasions), and puncture wounds. Other examples include incisions (clean cuts), lacerations (jagged, irregular cuts), diabetic ulcers, and burns. While most minor wounds heal easily, some can worsen into chronic open sores that can become seriously infected. You may be able to treat minor wounds at home, but you should seek emergency care for any animal or human bite or a cut greater than ½ inch long where you can see fat, muscle, or bone.

Signs and Symptoms:

The following signs and symptoms often accompany wounds:

• Bleeding or oozing of blood
• 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?:

Accidents or injuries usually cause wounds, but can they can have any of the following causes:

• Surgery
• Heat or chemical burn
• Temperature extremes (frostbite)
• Radiation

Who's Most At Risk?:

People with the following characteristics may be at higher risk of wounds:

• Age -- Older people are at higher risk
• Poor general health
• Steroid use
• Radiation and chemotherapy
• Diabetes
• Smoking

What to Expect at Your Provider's Office:

If you receive a serious wound, you should get emergency treatment right away. Your health care provider will determine the extent and severity of the injury, whether infection is likely, 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. You may also need a tetanus shot or a tetanus booster.

Treatment Options:

Prevention

Most wounds are accidental and often preventable. Make your home safe by removing any objects that might cause trips or falls, keep the water heater at 120 degrees, keep knives and hot pots and pans away from the edge of counters, and pay close attention when using knives. Once you've received a wound, carefully cleaning and bandaging it can usually prevent infection and other complications.

Treatment Plan

Some wounds, such as minor cuts and scrapes, can be treated at home. Stop the bleeding with direct pressure, and clean the wound with water -- you don' t need soap or hydrogen peroxide. Apply an antibiotic cream, then cover the wound with an adhesive bandage. Change the bandage every day or when it gets wet. If any redness spreads from the wound after two days, or if you see a yellow drainage from the wound, see your doctor immediately.

Other wounds can be serious. Get emergency care immediately if the wound won' t stop bleeding or spurts blood, if the wound is from an animal or human bite, or if there is a serious puncture wound. If an object (nail, fishhook) is still stuck in the wound, don' t take it out. Apply pressure to the wound to stop bleeding, and go to the hospital.

Some serious wounds may need 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 with stitches, or whether it must be kept open because of contamination. Infected wounds are not closed until the wound has been successfully treated.

Drug Therapies

Your health care provider may prescribe the following medications:

• Analgesics, or pain relievers -- such as acetaminophen (Tylenol) or ibuprofen (Advil, Motrin)
• Antiseptics, to clean contaminated wounds
• Antibiotics for infections or sepsis (caused by disease-causing bacteria, accompanied by a strong odor)
• Medicated dressings
• Corticosteroids
• A tetanus shot

Surgical and Other Procedures

Some severe wounds may need surgery. 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 received thorough medical attention. If you have any question about whether 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

Some nutritional supplements may help wounds heal, although not all have good scientific studies behind them. You can also take these supplements before surgery to reduce healing time. Lower the dose or stop use when your wound has healed.

• Beta-carotene (250,000 IU a day) or vitamin A (15,000 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 5,000 - 10,000 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. Talk to your doctor before taking vitamin A if you are scheduled to have surgery.
• Vitamin C (1,000 mg two to six times per day) helps the body make collagen and is essential to wound healing because it helps the body form new tissue. Lower dose if diarrhea develops.
• Vitamin E (400 - 800 IU a day) promotes healing. May be used topically once the wound has healed and new skin has formed. Higher doses may help heal burns. Talk to your doctor before taking vitamin E if you are scheduled to have surgery.
• 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. If you take zinc long-term, ask your doctor if you also need to take copper.
• 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), an enzyme derived from pineapple, has reduced post-surgical swelling, bruising, healing time, and pain in some studies. Bromelain may increase the risk of bleeding. If you take blood-thinning medications, such as warfarin (Coumdain) or aspirin, ask your doctor before taking bromelain.
• 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 be sure. If you have asthma, ask your doctor before taking glucosamine. Glucosamine may interact with some medications, including cancer drugs and possibly acetaminophen (Tylenol). Talk to your doctor to find out if glucosamine is an option for you.
• L-arginine (17 - 25 g per day) has been used to improve healing time in surgery patients. It has also been applied to the skin to help heal wounds. Use caution if you are prone to herpes outbreaks, and talk to your doctor. If you have asthma, take medication for high blood pressure, or use Viagra, ask your doctor before taking arginine.
• Honey has been used topically as a dressing after surgery, and some studies suggest it helps wounds heal without becoming infected. Talk to your doctor before using honey on minor wounds, and do not apply honey to an open wound.

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 to skin

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

• Aloe (Aloe vera), as a cream or gel. Aloe has been used traditionally to treat minor wounds and burns, but scientific studies about its effectiveness are mixed. In one study, aloe seemed to make surgical wounds take longer to heal.
• Calendula (Calendula officinalis), or pot 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.
• Gotu kola (Centella asiatica) as a cream containing 1% of the herb, to help heal wounds.
• Chamomile (Matricaria recutita or Chameaemelum nobile), as an ointment or cream, to help heal wounds.
• Echinacea or coneflower (Echinacea spp.) 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 by mouth

• Turmeric (Curcuma longa) is an anti-inflammatory that makes the effects of bromelain stronger. Use dried extract 250 - 500 mg three times a day. Turmeric may increase the risk of bleeding. If you take blood-thinning medications such as warfarin (Coumadin) or aspirin, ask your doctor before taking turmeric.
• Gotu kola helps the body repair connective tissue and heal wounds, 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. Do not take gotu kola if you have hepatitis or liver disease.
• Coneflower and goldenseal (Hydrastis canadensis), used together, may help protect against infection. Use equal parts tincture 30 - 60 drops three to four times a day.
• Dandelion (Taraxacum officinale, 2 - 8 g per day) is another herb with anti-inflammatory and antioxidant properties. It may help with wound healing, although there are no scientific studies looking at dandelion for wound healing. 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

Before prescribing a remedy, homeopaths take into account a person's constitutional type -- your physical, emotional, and psychological makeup. An experienced homeopath assesses all of these factors when determining the most appropriate treatment for each individual.

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:

Most minor wounds heal quickly. For more severe wounds, the prognosis depends on the extent of the wound, as well as any infection that might develop. There are several complications associated with wounds: infection, keloid scar tissue (an overgrowth of scar tissue), and gangrene (tissue death that may require amputation). Bleeding, sepsis, and tetanus (a potentially fatal infection of the nervous system) are also complications that can occur.

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 mean an infection.