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Choosing your wound dressing carefully can help reduce pain and minimise scarring

The natural way to heal cuts and wounds

Cuts, grazes, wounds, and lacerations – to varying degrees we have all had to deal with them at one time or another. If you go into hospital for surgery – even the minimally invasive variety – you also have the problem of how best to help a wound heal.

Your skin is your body’s largest organ and plays a major role in keeping you healthy. Given optimum conditions, the human body is remarkably efficient at repairing injuries to this important barrier.

When the skin is cut complex biochemical reactions are instigated. These include the activation and/or destruction of cellular and molecular elements including white blood cells, red blood cells, endothelial cells, and platelets – all part of the initial inflammatory process. Inflammation – far from being undesirable –  is what protects the site from further injury while it begins the process of tissue repair.

In spite of all this we continue to try and beat Nature at her own game, applying sutures, harsh antiseptics and lots of dry, absorbent bandages to ‘help’ wounds heal better. Many of these practices in wound management have been put to the scientific test in recent years – and many of them have proven more harmful than helpful.

Cleaning with dirty chemicals

For example, even though a healthy body is well equipped to fight off invading bacteria, wounds get rubbed with alcohol, antibiotics, iodine, mercurochrome, merthiolate, hydrogen peroxide and other medications to keep them ‘clean’. Today antiseptics such as hydrogenperoxide, povidone iodine, acetic acid, chlorohexadine, cetrimide and Dakin solution (sodium hypochlorite) all find a place in the family medicine cupboard.

Unfortunately many of these strong antiseptics can also interfere with the body’s own healing mechanisms.  In fact, cleaning a wound is often the first mistake we make, since antiseptic solutions can interfere with the process of wound healing in several important ways.

All wounds need to be cleaned before they are treated. The problem is that antiseptics don’t just kill germs, they also kill beneficial leucocytes, the body’s own bactericidal cells, as well as fibroblasts, cells that eventually form new skin.

Current thinking is that all but the worst types of wounds can be safely and effectively washed with a simple saline solution. Very dirty wounds can be cleaned with water pressure – in the hospital staff may use special equipment, at home running water or a showerhead may be just as effective.

The benefits of moisture

Likewise attitudes to ‘simple’ bandages – used to keep the wound clean and dry – are changing.  No one would argue over the benefits of providing a degree of protection to wounds. But keeping it dry, usually with a gauze bandage that allows air to get to the site, and allowing a scab to form, while it doesn’t always slow the healing process, does seem more likely to leave a scar.

As far back as the 1960s research was showing that wounds that were kept moist healed better than those left to dry. However, it has taken until relatively recently for gauze-based bandages, to give way to ‘semi-occlusive’ bandages that effectively maintain the moisture balance of the wound site by sealing it off  but also allowing the transmission of oxygen, nitrogen and water vapour.

The natural environment of the cell is moist. Dry cells – for instance hair and nails – are dead cells, incapable of reproducing at their point of origin. Perhaps the most important benefit of a moist bandage is that it provides an optimum environment for cells to stay alive and replicate.

Supporting the healing process

A wound is a break in the protective barrier of the skin. It allows moisture to escape from the underlying moist tissue and causes the death the superficial cells, a process that results in the familiar scab, composed largely of dried blood and other fluids.

While traditional thinking is that the scab is nature’s own barrier to moisture loss, newer thinking sees the scab as an inefficient barrier to moisture loss. Scabs also prevent new cells from colonising the wound area. When a scab is allowed to form, epidermal cells have to penetrate deeper into the dermis where the environment is moist before they can proliferate. This means that the wound will only heal from the bottom up whereas in a moist environment the wound heals from the sides and bottom at the same time.

Newer moist dressings such as polymer films and foams, hydrocolloids, hydrogels and calcium alginates allow much less moisture evaporation and may also act as insulation, helping to maintain the optimum temperature needed to support the process of cell replication.

Keeping infection at bay

Moist dressings are also many times more effective than dry dressings at preventing infections. This is as important for the child in the playground as it is to the patient in hospital, where opportunistic antibiotic resistant bacteria can so easily enter a wound site.

In this respect, moist healing is something of a paradox. Most of us would assume that a moist environment would be a breeding ground for germs, but this belief does not acknowledge how efficient the body can be at fighting infection. Nor does it acknowledge that a wound colonised by bacteria is not necessarily at risk of infection.

All wounds, no matter how carefully cleaned, are colonised by bacteria. The problem arises when harmful bacteria are given the opportunity to multiply. In a properly nourished body, natural infection fighting mechanisms can effectively keep these bacteria in check.

Moist healing actually helps decrease the likelihood of infection. There is evidence, for instance, that while bacteria can penetrate up to 64 layers of gauze they are incapable of penetrating a single layer of polymer film. There is also evidence to show that the infection rate of wounds covered with gauze is 7% compared with 2% for a moist hydrocolloid dressing.

One reason for this may be that a moist dressing helps to maintain the slightly acidic condition of the skin which helps to inhibit certain types of bacteria including Staphylococcus aureus and Pseudomonas aeruginosa.

Less pain too

Patients also report less pain when wounds are kept moist. Newer dressings may also protect nerve endings helping to reduce the perception of pain. They also do less damage to the wound site when a dressing is being changed.

Another intriguing possibility about the effectiveness of moist dressings is that they help to maintain the electrical integrity of the wound site.

By keeping the site moist it allows the body’s own electrical current to flow more or less uninterrupted. It has been shown that the electrical charge of wound tissue is positive, relative to the surrounding intact skin. This positive current is thought to orchestrate the migration of healing cells to the site, but cannot flow if the skin is dry.

This understanding provides a context into studies of electroacupuncture and the successful healing of a variety of wounds, even those that had failed to heal with prior conventional therapy.

Tips for natural wound healing

From time to time, we all get cuts and grazes, and there are now a number of good alternatives to the usual antiseptic creams that are the stock in trade of most chemists.

Taking care of a wound or cut is largely a matter of common sense. When self-treating, consider these options to help support the body’s own efficient healing process:

Stop the bleeding The sooner you can cover the wound and stem the blood flow, the easier the injury will be to deal with. To stop bleeding apply pressure that is firm and even – too much will cut off the circulation. Don’t keep checking to see if the blood has stopped; you might disturb the clotting/healing process. If there’s a lot of blood seeping through the padding you’re using, don’t remove the padding; cover it with another cloth or pad and continue to apply pressure.

Clean it carefully Rinse under running water or wipe with cotton wool, from the centre of the injury outwards, to remove any grime. From time to time during the healing process make sure the wound is cleaned with a gentle saline solution. You can make one at home by putting two teaspoons of salt into a litre of boiling water and allowing this to cool. Or try using a rinse made of neat calendula mother tincture (or, if you prefer, one part tincture to 10 parts water).

Use a natural antiseptic A good first choice is Echinacea angustifolia which fights infection and also promotes healing. Others include calendula, tea tree and lavender.

Supplement A poor diet in general can slow wound healing and essential fatty acid deficiencies are also associated with poor wound healing. Vitamin A helps to form scar tissue, B1 (thiamine) deficiency can interfere with collagen synthesis and B5 (pantothenic acid) accelerates the healing process. Vitamin C promotes the formation of collagen and elastin and deficiency can slow the healing process, vitamin E aids in the healing of skin grafts; zinc stimulates wound healing. Supplementary zinc also plays an important, but often overlooked, part in wound healing.

Boost your protein intake Skin is made of protein and extra is required when you are injured. This is especially true for those undergoing an operation since surgery increases calorie and protein needs by 20% to 50%. Your body needs this to manufacture immune cells and antibodies, to reduce inflammation and to mend the wound at the site of incision. Without enough protein recovery may be delayed and the risk of infection is higher. 

Herbs A wide range of herbal creams are available including calendula, echinacea, tea tree oil, and hypercal cream or tincture (containing hypericum and calendula). Hypericum (St John’s wort) tincture on its own is useful for relieving pain in injured areas rich in nerves. A traditional remedy to both heal and fight infection combines hypericum, sage and oregano oils in a base of olive oil. Aloe vera can also help heal minor wounds; but it should not be used on deep or surgical wounds as it has been shown to delay healing. Comfrey comes with a similar caution. It is great for use on shallow cuts and grazes, but is best avoided on very deep wounds since it may cause the skin surface to heal before the deeper layers of tissue have fully healed.

Homoeopathy Arnica will treat stress from the injury. Silicea is useful in helping to remove foreign bodies such as splin­ters or thorns. If these are deeply embedded, it may be better to use this remedy instead of probing an already sensitive wound. Hepar sulph and Belladonna may also be useful in helping clear up infections.

Heal it with Honey Honey contains enzymes and anti-viral substances that may have active benefits for wounds. In studies honey impregnated gauze was found to promote faster healing, and result in less infection. It has also been found to actively promote the growth of new epithelial cells. Manuka honey is particularly effective.

If you have stitches You can usually wash an area that has been stitched after one to three days. Washing off the dirt and the crust that form around the stitches helps reduce scarring. Be sure to dry the site well after washing. If the wound drains clear yellow fluid, you may need to cover it.  Ointments, rather than creams or lotions, will keep a heavy scab from forming and may help reduce the size of a scar.

Healing scars Moist dressings should result in fewer and less noticeable scars. However if you do have scars silicone sheeting may be one way to help. Studies show that silicone sheets can improve the appearance of hypertrophic and keloid scars resulting from surgical procedures or trauma. They are most effective on fresh scars but should not be used until the cut has closed. Although it’s largely been overtaken by silicone, glycerine-based gel sheeting can be just as effective and less expensive. Simply keeping scars moist for a longer period may be of the most benefit. Topical vitamin E oil may also be helpful.

Know when to call a professional Cuts that require medical attention include those that are deep (how deep is usually more important than how long). They also expose any red muscle tissue or yellowish fat tissue; stay open if you let go of the sides of the cut; or are sited on a joint or in an area where healing might be difficult (stitching might be needed to keep it closed). If medical attention is required discuss the pros and cons of different types of dressings with your doctor. For instance, alginates are best used on wounds leaking lots of fluid, while hydrogels and hydrocolloids boost moisture in dry wounds. Selecting the right dressing can substantially boost healing.