Wound Healing and Care

All kids get cuts and scrapes that parents can take care of at home. But what about more serious wounds, such as those that involve stitches or a hospital stay?

Different Types of Wounds

Most of us think of wounds happening because of accidents. But even clean surgical incisions (cuts) are wounds. So are places where tubes or catheters go into the body. Skin is the body's largest organ and helps protect it from germs (bacteria, fungi, and viruses) that live on its surface. So, anything that breaks the skin is a wound because when the skin is broken, there's a risk of germs getting into the body and causing an infection.

The deeper, larger, or dirtier a wound is, the more care it needs. That's why a team of doctors and specially trained wound care nurses work together to monitor and treat serious wounds.

Doctors and nurses start by evaluating a wound based on the risk of infection:

• "Clean" wounds — those that aren't contaminated with bacteria — have the lowest risk of infection, making them easier to care for. The incision a surgeon makes on a person's knee during ACL repair is likely to be a clean wound because the area is cleaned with an antibacterial solution before surgery — and it's in a place where there's a low risk of infection.
• Dirty or infected wounds, like an abscess, a deep scrape or cut, or gunshot wound, are a different story. They need special treatment and monitoring to prevent infection.

Sometimes a wound is clean but there's a risk of infection because of where it is. Fluids and other contaminants can get into a wound that's in an area with more bacteria — like the urinary tract, gastrointestinal system, or respiratory system. Dirt or a foreign object in the wound also can increase the risk of infection.

Closing Serious Wounds

If a wound is clean, a doctor will close it by stitching the edges together in two separate layers. The doctor will use dissolvable stitches to join the deeper layer of tissue under the skin. Then he or she will staple, tape, or stitch the skin over it.

Sometimes doctors use dissolvable stitches or tape to join the upper layer of skin as well as the lower layer. Otherwise, the doctor will remove any surface stitches or staples after about 7 to 10 days.

Doctors don't always close a wound right away, though. If there's a chance a wound is contaminated, they will leave it open to clean it out (for example, with an animal bite). Closing a contaminated wound can trap bacteria inside and lead to infection. When they're sure no bacteria or other contaminants remain, they will stitch or close the wound.

Sometimes, doctors decide it's best not to sew up a wound at all. If someone has lost a lot of tissue (like after a serious accident), it's often helpful to leave the wound open to heal through natural scar formation.

The doctor will also ask about your child's tetanus vaccine status, to make sure it's up to date.

The Healing Process

Before healing begins, the body gears up to protect against infection. For the first few days, a wound may be swollen, red, and painful. This inflammation  is a sign of the body's immune system kicking in to protect the wound from infection. Keep the wound clean and dry at all times to help the healing process.

As the body does its healing work on the inside, a dry, temporary crust — a scab — forms over the wound on the outside. The scab's job is to protect the wound as the damaged skin heals underneath.

Under the scab's protective surface, new tissue forms. The body repairs damaged blood vessels and the skin makes collagen (a kind of tough, white protein fiber) to reconnect the broken tissue.

When healing is done, the scab dries up and falls off, leaving behind the repaired skin and, often, a scar. At this point, the scar will be almost 80–90% the strength of normal skin. It'll take a few months for the scar to be back to 100% strength of normal skin.

Scars look different from normal skin. That's because skin is made up of two proteins: elastin, which gives skin its flexibility, and collagen, which gives it strength. The body can't create new elastin, so scars are made entirely of collagen. They're tougher and less flexible than the skin around them.

Caring for Serious Wounds at Home

Serious wounds don't heal overnight. It can take weeks for the body to build new tissue. So good home care is important to prevent infection and minimize scarring.

The doctor will give you instructions on how to care for your child as the wound heals. In most cases, doctors ask patients to:

• Keep the wound covered with a clean dressing until there's no fluid draining from it. A doctor or nurse will give you instructions on how to change the dressing and how often.
• Wait about 2-4 days after surgery before showering. Because each case is different, ask your nurse or doctor what to do before your child can shower again.
• Avoid soaking in the bathtub or swimming until the next doctor visit. Dirt in the water could seep into the wound and contaminate it. Also, there's a risk that a wound might pull apart if it gets too wet.
• Try to keep pets away from the wound.
• Avoid picking or scratching scabs. A scab may itch as the skin underneath heals, but picking or scratching can rip the new skin underneath. The wound will take longer to heal and the scar it leaves may be worse.

Our bodies rely on vitamins and minerals to heal. Offer your child healthy foods — especially lots of vitamin-rich fruits and vegetables and lean proteins — while the wound heals. He or she should drink plenty of water and eat high-fiber foods like whole grains to avoid constipation. (Constipation can be a side effect of pain medicine.)

The wound might heal quickly, but scars can take longer. For thick scars, the doctor might recommend massaging the area with lotion or petroleum jelly. Doing this helps the collagen mingle with the elastin in the surrounding skin, decreasing some of the scarring.

When Should I Call the Doctor?

If a deep or large wound gets infected, it can be a serious problem. Call your doctor or surgeon right away if:

• Your child has a fever or swollen glands (or both).
• Your child has increased pain even with pain medicine, or the pain radiates out beyond the wound area.
• The area around the wound is getting more swollen.
• There's an expanding area of redness around the wound or red streaks on the skin around the wound.
• You see blood or pus draining from the wound.
• Your child has signs of dehydration, such as peeing less, dark pee, a dry mouth, or sunken eyes.

The good news about wound healing is that young bodies heal faster. Help your child take good care of the wound and follow the doctor's advice. Before long, the wound will be a distant memory.