So you have a minor cut or scrape. It’s bleeding but not serious enough for to be sutured. What do you do?
I had a girlfriend many years ago who believed that adhesive bandages were evil, and a wound needed to be “exposed to the air” to heal well. I didn’t really believe it, but it influenced me a little and for a while I was somewhat reluctant to cover a wound. Eventually I got over that, and for many years my process was:
Wash with soap and water
Wipe with an alcohol wipe
Put a dab of Neosporin on a Band-Aid and cover the wound
Once or twice a day, or if it gets wet, repeat steps 1-3 and replace the Band-Aid
A couple of years ago I became convinced that alcohol was not a good treatment; it does kill germs but also damages your tissue. So I switched step 2 to wiping with a BZK wipe.
Recently I and my wife have had a few minor surgical procedures, and in all these cases the wound care instructions were to apply Vaseline or Aquaphor. The doctors specifically advised that wounds heal better when covered with these creams rather than antibiotic creams such as Neosporin. That seems counterintuitive to me, but I guess I’m switching step 3 to use Aquaphor instead of Neosporin.
I’ve been influenced by the many traumas I had to deal with as an animal owner, and following veterinary protocols. First, lots and lots of water. If you have a mild antiseptic to add to the water (I use a few drops of betadine, enough to just color the water), that’s good, but the point is to really clean the area. Put some kind of vaseline or wound cream on it, doesn’t have to be antibiotic, and then a good bandage that seals all the way around. Change the bandage regularly.
Well, usually when I get an injury requiring a bandaid and all, I’m at work. In the past, the procedure would have been to wrap it as best you can with packing tape to staunch any bleeding and keep as much dirt and grime out of it as possible and just keep on working while trying to not bleed on the customer’s stuff. Clean it and bandage it as needed later. Now that I work more exclusively in the warehouse, the injuries are usually smaller and less bloody and there are first aid cabinets all over the place, well stocked with all manner of oinments and bandages and wound cleansing supplies. I usually take whatever bandaid off after a day or two as long as the wound is scabbed up and healing nicely.
ETA. We do keep first aid kits in all the trucks, and there is an attempt to keep them well stocked with first aid basics, but if people don’t report injuries because they’re afraid of getting put on “workmans comp” for a cut it’s hard to know the kit needs restocked.
If you do not like “adhesive bandages”, you can/should anyway have normal, sterile non-stick dressing and gauze wrap.
In your situation, you do not necessarily need any antibiotic creams and stuff for dressing the wound, but we are of course assuming that the wound has been properly washed and the surrounding skin cleansed with e.g. iodine solution.
Indeed, you want to stop active bleeding before irrigating the wound. Once I used an “Israeli bandage”, which applies pressure, for this and it worked; a useful item for your first-aid kit.
I generally regard the bleeding as a hassle mostly, because it makes a mess of things. I’ll rinse off a bleeding wound and then dry it off well enough to get a band-aid to stick. The band aid stays in place until the bleeding stops, but beyond that, the band aid itself is a hassle - especially if it’s on my hands, as it gets saturated when I wash my hands. It may heal faster if covered, but repeatedly replacing the bandaid and dabbing it with Vaseline is more than I can be bothered with; I’d rather put up with a scab a bit longer instead.
I’ll make an exception (and keep a bandaid on it for the long haul) if the wound is someplace where clothing will rub on it and make it bleed (e.g. inside a sock), cuz that ruins clothes.
I fell maybe 7 weeks ago, cut my knee. Went home and washed it, put a bandaid on as I don’t any creams or whatnot to put on one. Removed bandaid the next evening.
Cold water to stop the bleeding and wash the wound. Pressure if it’s really gory. If I’ve cut myself in a dirty part of my skin (like hands filthy from grooming horses or gardening) I’ll add a little soap of some sort. When the wound is clean and has mostly stopped bleeding I’ll dry the area gently and cover it with a bandaid or something. Gauze and a dollop of duct tape works well in a pinch. I’ll leave it covered until the bandage inevitably gets wet, then reassess. Sometimes it gets a new bandage, sometimes not. Depends on where and how bad it is. I only use topical abx if it’s looking really angry.
Unless I have specific reason to believe that the wound got particularly contaminated, I just wash it and then apply a bandage (usually one like a band-aid with the adhesive built in, but that depends on the shape and size of the wound). I keep the bandage on more or less until it falls off, by which time the wound has usually closed enough that it can just continue on its own.
If I have specific reason to fear contamination, then I’ll also use alcohol, with the rest the same.
Vaseline (petrolatum or ‘petroleum jelly’) is a hydrophobic and occlusive (air barrier) ointment that is not antimicrobial, and can potentially seal in anaerobic bacteria into a wound site. While your former girlfriend was wrong that wounds should be directly open to air, they should be capable of evacuating exudate (pus) and at least periodically exposed to oxygen to inhibit the growth of Staphylococcus bacteria, or else saturated in an antimicrobial ointment to inhibit bacterial growth. I’ve seen a lot of colloquial suggestions to use petroleum jelly to ‘seal’ a wound but I have not seen that recommended in medical literature and don’t carry Vaseline in my medkits, either for lacerations or burns. For punctures and lacerations I use an iodine solution and a topical antibiotic (or bandage with antibiotic solution) and for burns I use a surfactant burn gel.
As @Ulfreida notes, the imperative first step in wound treatment is irrigation and removal of any foreign debris, preferably with a syringe (without needle) or low pressure spray. Any water that you would drink is sufficient although a mild saline solution with a small amount of iodine solution is ideal, followed by a topical application of antibacterial ointment. Isopropyl alcohol, although useful for sterilizing instruments and injections sites, is not indicated for a wound site because it will cause inflammation and inhibit coagulation of platelets.
Following that, a cut with clean edges should be sealed together to promote healing, either by the use of butterfly closures or Steri-Strips®. If the wound is relatively shallow (only through the dermis) it can be covered with an occlusive dressing (preferably transparent so it can be inspected); this is particularly important in medical, food handling, or backcountry scenarios where exposure to pathogenic bacteria is frequently. If the wound is deep enough to require thread sutures then it should be covered with a removable dressing and a small section at one end upon to promote evacuation, and the patient evacuated to professional medical care as soon as possible. There are some specific procedures for closing deep wounds in the field without the use of thread sutures, which frankly if done without expertise can cause more problems than they reduce but in general if you have a deep wound that can’t be closed with adhesive bandages you need to seek medical care.
For minor abrasions and ‘clean’ lacerations, you shouldn’t have to replace bandages regularly because they should seal up with platelets quickly, forming an impermeable barrier to Staph and other micropathogens. For burns, application of burn gel and a loose dressing is recommended. For deeper wounds or with jagged edges, it is important to inspect the wound regularly for signs of infection, and respond to indications of sepsis promptly. One thing I learned in backcountry medical training is how seemingly minor injuries (particularly punctures and burns) can go from being minor irritants to major medical emergencies quickly if not promptly and correctly treated.
Well, as I said, both my wife and I had minor surgical procedures recently (excisions) and in both cases, the dermatological surgeon (two different surgeons) recommended keeping the wound covered with Vaseline or Aquaphor. Here are some dermatology organizations that make the same recommendation. Maybe treating a surgical incision requires different care than treating an ordinary wound?
I suspect that is the case. There is probably a significant difference between an open wound as you described and a wound that has already been sutured under sterile conditions. Just guessing.
In any case, for wound care outside a medical facility, bleeding control trumps all. If the bleeding is minor, it’s fine to wash the wound, either under running water or by flushing as Stranger describes. Otherwise squeeze it till the bleeding stops, in a sterile dressing, clean handkerchief, paper towel, whatever you’ve got.
Alcohol and full-strength antiseptics in the wound are not recommended. They’ll kill many bacteria, but also kill skin cells. Now the wound is lined with a layer of dead cells, providing an all-you-can-eat buffet for the remaining bacteria.
Cover with an adhesive bandage, or wrap with sterile gauze (improvising as best you can in wilderness or disaster settings). Save the petroleum jelly (or ointments containing it) for when the wound is reliably closed, and you need to keep the scab and skin from becoming dry and cracking.
This. If it’s a wound comprising a clean cut that you want to close and knit back together, over-sanitising the cut edges will kill the tissues at the joining edges and prevent that from happening and whilst it will still heal, it will do so from the bottom/inside outward - and you may experience a lot of peeling back of dead layers as it heals.
For me, if I get a minor cut I want to make sure the wound is clean, so I use lots of water. Then apply some pressure and cover with a band-aid or gauze+tape until properly scabbed. Sometimes I’ll use antibiotic ointment if the wound was dirty or if it shows signs of getting infected.
If it’s on my hands I usually use a “liquid bandage” which can survive a couple handwashings and some friction to protect the wound for a couple days. I find that I usually only need it for a couple days and it keeps the wound from re-opening and getting dirt/germs inside. But it’s important to only use that on a clean wound, and if there is any sign of infection you need to remove it and use antibiotics or even medical attention. In which case I go through a LOT of band-aids until things improve, as I will dry the wound are and re-bandage every time I wash my hands.
Topical antibiotic ointments continue to be recommended for sutured wounds because they help keep wound edges moist and prevent dressings from sticking. However, they have not been proven to reduce infection or enhance healing.
In fact, the whole section on “How To Cleanse, Irrigate, Debride, and Dress Wounds” is relevant to this discussion since it gives a step-by-step textbook procedure.
No ointment or cream is going to prevent pus from getting out and the oxygenation needed comes from the blood flow not external exposure.
Yes first and foremost above all else is copious irrigation. NOT with iodine or alcohol which definitely causes more harm by way of tissue necrosis than good by reducing bacteria counts.
Healing is then best facilitated by maintaining a moist environment. Best is a hydrogel either applied or as a dressing. Moist keeps the tissues from drying out and allows all the body’s healing messengers and cells (including cytokines and new skin cells) to get where they need to be fastest.
For non surgical wounds a topical antibiotic ointment does help reduce local infection risk in addition to keeping the wound moist. Petrolatum fine for surgical ones, and it helps getting the stitches out easier too as it cuts down on scabs drying over them.
That said most minor home wounds will do fine pretty much no matter what. I don’t personally bother to stock a hydrogel and usually just wash off well, pressure until bleeding definitely stopped, and slap on a bandaid. But it is not best.
Thing is, most triple antibiotic ointments, especially the cheaper ones, are compounded with a petrolatum base anyway. So there’s no real advantage to not using them in favor of vaseline/aquaphor, at least as far as wound protection goes.
The jury’s still out about whether or not routinely using antibiotics on minor wounds contributes to antibiotic resistance or not.
If I"m using some sort of antiseptic, usually if I have a skinned knee or other large abrasion like that, I typically use povidone-iodine (Betadine).
I typically try to keep it covered as long as I can, and change daily. In practice, this means that skinned knees/elbows and cuts in other places beyond my hands end up getting a bandage change daily. Hand cuts usually get a two or three days of being washed/re-ointmented/re-bandaided after every time I wash my hands (every time I use the bathroom, etc…) but they eventually end up just getting washed and dried like the rest of my hands and end up healing however that shakes out.
Most wounds do heal faster if you keep them covered and ointmented. It’s kind of a trade-off; if you let them scab up, you’re trading convenience for a longer healing time, and vice-versa if you try to keep them covered, etc…
I have to admit that the newer blood-stopping products are pretty cool, and they do indeed work. I used one of those oxidized cellulose one on my thumb when I cut it pretty well washing dishes, and it stopped the bleeding in something like six seconds, and the wound healed up really quickly. I was surprised at both the speed that it stopped bleeding, and the speed at which it healed. It was almost like it never did that usual “emit liquid/slightly bleed” phase that happens after you stop the immediate bleeding, and went straight to the healing phases.
The last major wound I also would have done nothing for, except I was with a pig farmer and he had antiseptic and tissue paper in his truck. Got a 4 inch, 1 inch, and half inch scar on my left forearm. Duct taped the tissue on. Plenty of blood but I knew it was a shallow cut.
Never help a pig farmer move a shed across an electric fence!
But really, if I don’t need to go to hospital, it probably will work out OK
If it gets infected, then most likely hospital time.
ETA, not sure if this counts as a wound, but I sprained my right second toe, about a week before an incredible hike planned.
I chose to take a lot of painkillers with me, and duct taped my big toe to the second toe.
780m ascent followed by 600m descent, followed by 4 days kloofing. I survived.