Wounds

Everyone receives wounds over the course of their lifetime. A wound is a break in the structure of an organ or tissue caused by an external agent. Most wounds affect the skin the first line of defense against infection. Commonly recognized 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 some wounds heal easily approximately five million Americans suffer from chronic open sores that can become seriously infected.

Signs and Symptoms

Wounds are often accompanied by the following signs and symptoms.

• Abnormal flushing of the skin
• Swelling as a result of the accumulation of fluid in body tissues
• Pain and tenderness
• Heat
• Possible fever with infection
• Bleeding or oozing pus
• Loss of function (or mobility)
• 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 (e.g. burns 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 provider will determine the extent and severity of the injury possible contamination and conditions that might complicate treatment. He or she may also order laboratory tests such as a blood test and urinalysis as well as a culture to check for bacteria in the wound. Your provider may also suggest you get a tetanus vaccine.

Treatment Options

Prevention

Most wounds are accidental and often preventable. Once you've received a wound infection and other complications can be prevented 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 a gentle cleanser and stop the bleeding then cover with an adhesive bandage. Other wounds particularly those where the bleeding will not stop or any wounds resulting from animal or human bites or fishhook injuries (do not remove the hook) can be serious and must be treated by a health care professional. 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 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
• Growth factors (substances that stimulate healing)

Surgical and Other Procedures

In the case of severe wounds surgery is sometimes needed. This may involve cutting out burned tissue and removing contaminated tissue skin grafting and draining wound abscesses (pus surrounded by inflamed tissue).

Complementary and Alternative Therapies

A comprehensive treatment plan for wounds may include a range of complementary and alternative therapies.

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 wound has healed.

• Beta-carotene (250 000 IU a day) or vitamin A (50 000 IU a day) to promote healthy scar tissue. These are high doses and should not be taken for longer than one to two weeks without your provider's supervision. Reduce dose to 50 000 IU of beta-carotene and 15 000 to 25 000 IU of vitamin A daily after two weeks. Do not take vitamin A if you are pregnant or trying to conceive.
• Vitamin C (500 to 1 000 mg three times a day) enhances tissue formation and strength.
• Vitamin E (400 to 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 to 30 mg a day) stimulates wound healing.
• Bromelain (250 mg three times a day between meals) reduces postsurgical swelling bruising healing time and pain.
• Seacure (3 capsules two to three times a day) is hydrolized whitefish protein that provides absorbable protein necessary for wound healing.

Herbs

Certain herbal remedies may offer relief from symptoms.

• Turmeric (Curcuma longa) is an anti-inflammatory that enhances use of bromelain. Use dried extract 250 to 500 mg three times a day.
• Gotu kola (Centella asiatica) 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. It may also be applied topically to burns to minimize skin shrinking. Note that gotu kola can cause sleeplessness and anxiety in some people. Reduce the dose if this happens.
• Coneflower (Echinacea purpurea) and goldenseal (Hydrastis canadensis) used together protect against infection. Use equal parts tincture 30 to 60 drops three to four times a day.
• Powders of goldenseal comfrey (Symphytum officinale) and marshmallow root (Althea officinalis) enhance healing and minimize infection. Apply to the skin surface. Washes or compresses of cooled tea containing these herbs may also be used.
• St. John's wort (Hypericum perforatum) oil helps prevent postsurgical adhesions and may relieve nerve pain. Apply to the skin.
• Aloe vera gel provides excellent pain relief and speeds healing. Apply to burns and wounds.
• Marigold (Calendula officinalis) and plantain (Plantago major) aid in healing. Can be used on the skin as salves or creams. These herbs should only be used on incisions or "clean" wounds. Due to their fast action they could keep an infection from healing.
• Granulated or confectioner's sugar applied to the skin can help heal skin ulcers such as those caused by diabetes or bed sores.

Herbs are generally available as dried extracts (pills capsules or tablets) teas or tinctures (alcohol extraction unless otherwise noted). Dose for teas is 1 heaping tsp./cup water steeped for 10 minutes (roots need 20 minutes).

Homeopathy

Some of the most common acute remedies for wounds are listed below.

• Arnica for bruised feeling and grief and/or shock from trauma
• Staphysagria for pain from lacerations or surgical incisions
• Symphytum for wounds which penetrate to and involve bone
• Ledum for puncture wounds
• Urtica for burns
• Hypericum for injuries and trauma to nerves
• Keloid gel (Wala) for keloids

Acute dose is three to five pellets of 12X to 30C every one to four hours until symptoms are relieved.

Prognosis/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); gangrene (which may require amputation); wound hemorrhage; sepsis; and tetanus (a potentially fatal infection of the nervous system).

Following Up

Check for signs of bleeding discoloration or swelling in and around the wound. Inform your provider if you experience fever increasing pain and the development of 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.

Fauci AS Braunwald E Isselbacher KJ et al eds. Harrison's Principles of Internal Medicine. 14th ed. New York NY: McGraw-Hill; 1998:837 839 902-905 947 968.

Hardy JD et al. Hardy's Textbook of Surgery. 2nd ed. Philadelphia Pa: J.B. Lippincott; 1988.

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

Murray MT. The Healing Power of Herbs. Rocklin Calif: Prima Publishing; 1991:184 185 207.

Nettina SM. The Lippincott Manual of Nursing Practice. 6th ed. Philadelphia PA: J.B. Lippincott; 1996:90-91.

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

Schwartz SI et al. Principles of Surgery. 5th ed. New York NY: McGraw-Hill; 1989:201-205 301-302 320-323 470-473.

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

Copyright © 2000 Integrative Medicine Communications

The publisher does not accept any responsibility for the accuracy of the information or the consequences arising from the application use or misuse of any of the information contained herein including any injury and/or damage to any person or property as a matter of product liability negligence or otherwise. No warranty expressed or implied is made in regard to the contents of this material. No claims or endorsements are made for any drugs or compounds currently marketed or in investigative use. This material is not intended as a guide to self-medication. The reader is advised to discuss the information provided here with a doctor pharmacist nurse or other authorized healthcare practitioner and to check product information (including package inserts) regarding dosage precautions warnings interactions and contraindications before administering any drug herb or supplement discussed herein.