Wound Care and Scar Management

​A) ACUTE WOUNDS
An acute wound is an injury to the skin that occurs suddenly, rather than over a period of time. Acute wounds can occur anywhere on the body and vary from superficial scratches to deep wounds that damage deeper structures such as blood vessels, nerves, muscle or tendons. They include injuries such as cuts (lacerations), scrapes (abrasions), bites, puncture wounds and burns.

Minor acute wounds can be treated at home with general first aid principles. These include:

• Washing and disinfecting the wound early to remove all dirt and debris
• Applying direct pressure to stop bleeding
• Applying ice for bruising or swelling
• Wrapping the wound with a sterile dressing or bandage
• Elevation of the affected body part to control swelling

However, you should see a doctor if your wound is large, long or deep, or if the bleeding does not stop on its own. You should also visit the doctor if you are uncertain about how to look after your wound. Good wound care is important to speed up wound healing and prevent complications such as infection and poor scarring.

Treatment
Your doctor will evaluate your wound and determine whether there are any associated injuries of the deeper structures. Depending on the nature and severity of your injury, you may require:

• Cleaning of the wound under local or general anaesthesia
• Removal of embedded foreign material
• Repair of cut structures
• Repair of broken bones (fracture fixation)
• Regular wound dressings until the wound heals naturally (healing by secondary intention)

Painkillers and antibiotics are generally prescribed to control the pain and prevent or treat infection. Your doctor will give you follow-up appointments to monitor the progress of your wound to ensure that it heals well.

B) CHRONIC WOUNDS
A chronic wound is a wound is slow to heal or has failed to heal after several months. Examples include diabetic ulcers, venous and arterial ulcers of the leg, and pressure ulcers. Some of these wounds may never heal without specialist intervention. Early review by a specialist team is therefore important to correct risk factors and optimise wound healing conditions.

Risk factors
Risk factors for poor wound healing include:

• Poor blood supply
• Poorly-controlled diabetes
• Infection
• Poor nutrition
• Pressure injury from friction and immobility
• Poor immunity
• Smoking

A specialist review can determine if you have any of the above risk factors and recommend the appropriate steps to correct these problems in order to optimise the wound healing environment.

Treatment
Depending on the cause and condition of your wound, your plastic surgeon may recommend one of more of the following interventions:

• Antibiotics
• Negative pressure wound therapy
• Specialised wound care products
• Hyperbaric oxygen therapySurgery to clean up the wound under local or general anaesthesia
• Reconstructive surgery: for example, transfer of a flap (a thick piece of flesh containing skin, fat and/or muscle) to fill up the wound cavity with healthy tissue which has better wound healing potential

C) SCAR MANAGEMENT
After you have recovered from your injury, you may be concerned about scarring, especially if you were wounded on a prominent part of your body such as your face.  Unfortunately, scar formation is the body’s normal response to damage and is thus inevitable after any form of injury. However, proper scar treatment can help the scar to heal such that it is as inconspicuous as possible. Things that can improve your scar outcome include:

• Good wound healing without complications such as infection
• Avoiding exposure of early scars to the sun to reduce hyperpigmentation
• Pressure therapy such as scar massage and compression bandaging
• Topical medication such as silicone gel or sheets
• Lasers (Lasers -> hyperlink)
• Injection of medication into the scar such as steroids
• Surgery

Some of the above measures are also appropriate to treat old scars that you may have such as acne scars, or keloids.

It is good to consult a plastic surgeon early if you have a scar that you are worried about as better outcomes may be achieved with earlier intervention.