What I Wish I Knew About Wound Healing transcript

today we're going to talk about wound healing myths and I'm gonna bust them okay we're going to be talking about why is it bad to let a wound breathe all right we're going to talk about alcohol and hydrogen peroxide and why those you know traditionally were recommended for cleaning wounds but it is a bad idea I'm going to talk about scabs are scabs good or bad and should you remove them we're going to be talking about antibiotic healing ointments scarring and then swimming with a wound is that a bad thing or a good thing and what's the myth all right let's get into it wound healing myths busted let's go welcome back to Citizen surgeon my name is Dr Eric Pearson I'm a surgeon and today we're talking about wound healing myths and I am GNA bust them all right and so there are a ton of myths associated with wound healing now I've done a bunch of videos on wound healing I'm going to mention those throughout today and if you need some more information I'm going to direct you in so definitely watch those videos but let's get right into it what is the first myth well the first myth and I hear this all the time is well you gotta let a wound breathe let a wound breathe you hear it dry that wound out well that is a myth and that is a bad idea we do not want want wounds to be in a dry environment we want wounds to heal in a moist environment and I'm going to give you nine reasons for that okay so first is cellular migration and proliferation so in the first wound healing video that I did wound healing 101 I talked about the stages of wound healing in all the cells involved so we need keratinocytes we need fiberblast to lay down collagen and that doesn't happen in a dry wound bed so we need a moist environment for cellular migration and cellular proliferation the second reason is growth factors in cyto kindes involved in healing I talked about these as well so transforming growth factor beta there are a lot of different cyto kindes and if we have a dry wound bed we're not going to get efficient production of those cyto kindes to promote wound healing third is that a dry wound bed leads to Cellular death and we don't have an environment that promotes cellular growth so if we have dehydration or drying out of a wound we're going to get cellular death at the wound edges all right and that is where wound healing is occurring that reepithelialization of the wound is happening at the wound edges and if they are dry if that wound is breathing and drying out and dehydrated those keratinocytes those fiber blasts are going to die all right also things like macrophases and neutrophils and the early inflammatory part of wound healing are going to be impaired as well so that's the third reason letting a wound breathe is a bad idea what's the fourth reason now the fourth reason and we're going to talk about scabs a little later but if when you have a dry wound you're going to get a scab or you're going to get an esar and what is that that's built up dead cells and debris and what can a scab or an NR do that can trap bacteria in other dead tissues foreign body that you don't want in the wound trap it in the wound so when we dry out a wound we're more likely to get a scab and that is a bad thing for wound healing a fifth reason that drying out letting it breathe is a bad idea is we get a massive imbalance in our wound healing so if we want an optimal balance to get through all of the stages with wound healing we need to create a moist environment so for example if we have a dry environment we've let that wound breathe we're going to have more irritation of the wound we're going to have more trauma to that wound that wound is not protected we're going to have more bacteria entering the wound and that all impairs wound healing so a fifth reason that letting a wound breathe is a bad bad idea you want a few more I'm going to give you a few more let's get to a sixth reason well a sixth reason is if we have trauma to the wound and increased irritation to the wound and more bacteria getting into a wound that wound is going to hurt and so if we keep a wound protected and we keep a moist environment we have reduced trauma and we're going to have reduced pain and reduced inflammation so that sixth reason is letting a wound breathe hurts okay so we want to avoid that the seventh reason and this gets back to number one which is cellular proliferation is we get faster reepithelialization of the wound if we keep it protected in a moist environment so that wound healing is occurring from the edges and we are going to get reepithelialization of that wound with the Keratin aites and the fiberblast laying down collagen if we keep it in a moist environment well the next reason number eight is reduced risk of infection so if we protect a wound in a moist environment we're going to have a healthy balance of cells okay so we're going to have macras that are going to be removing bacteria debris foreign body from the wound we're also going to have fiber blast laying down collagen and reduced incidence of infection so if we let the wound breathe we have more trauma more bacteria and a higher risk of infection so that eighth reason is for reduce the risk of infection and number nine for many of you this might be the most important one I and I got to say it it's reduced scar formation so when we have scabs and we have esars and we have repeated trauma to a wound we have much higher likelihood of having a scar so keeping a moist environment keeping that wound protected until it's fully healed reduces in a much improved scar so those are nine reasons why letting a wound breathe is a myth and it is is generally a bad idea now I got to say that if you have a wound don't take my word for it you got to see a health care professional make sure you see your doctor your PA nurse practitioner whoever is guiding your health care if there is something you're worried about okay so let's get on to the second myth well what is the second myth the second myth is about alcohol and hydrogen peroxide and this idea that you need to clean the wound with alcohol and hydrogen peroxide and that is an old wife's tale that is not true that is a total myth and I'm going to tell you why so alcohol and hydrogen peroxide are commonly used disinfectants I do have both in my house hydrogen peroxide I use for cleaning shoes but that is about it I definitely don't want to use it in wounds and why is that well both of these are massive irritants and they cause cellular death now do we want cellular death when we're doing wound healing no we want cellular proliferation of course the right cells but alcohol and hydrogen peroxide it doesn't select which cells to kill so it kills everything and that can cause significant wound irritation and impaired wound healing there are plenty of studies that have shown that even at low concentrations hydrogen peroxide can cause oxidative damage to both keratinocytes and fiber blast and impair their ability to heal the wound so traditionally we thought well if we have a very clean wound bed and we disinfect that wound we're going to have improved wound healing you know we get the hydrogen peroxide it Foams you know that that is a really good sign but in instead now we know since wound healing is very complex process we know that it actually damages the wound bed and impairs wound healing what are some of the ways it does that well it can disrupt growth factors in cyto kind so platelet derived growth factor pdgf or transforming growth factor beta those are crucial for wound healing and alcohol and hydrogen peroxides can denature those proteins make them ineffective both of these disinfectants can increase inflammation and increase the risk of scarring if we have increased inflammation in wound bed fiber blast may be laying down collagen in a disorganized pattern and that can lead to worse scarring hydrogen peroxide itself can cause increased oxidative stress and that can be very impairing of both fiberblast and keratin aites when we're laying down new cells alcohol dehydrates things so alcohol is going to cause that wound to dry out we just talked about all the reasons why a dry wound bed impairs wound healing and finally hydrogen proxer alcohol just lacks effective de bment so while you think that foam is doing something it's actually not even as good as using sterile water or sterile saline to gently de breed and irrigate a wound so alcohol and hydrogen peroxide to clean a wound is a complete myth I hope I've given you enough evidence to believe that all right let's get on to number three what is the third myth well the third myth that I want to talk about is scabs are good scabs are sign of excellent wound healing that is a myth I'm sorry to say scabs are not good SE scabs as we talked about are signs of a dried out wound built up Sr and dead skin cells is not good for wound healing and let's dive into that just a little bit more so what are scabs scabs happen when blood and wound exate hardens dries out and forms over the wound well what is one reason that scabs are not good scabs are bad well they create a physical barrier to Healing cells to repair that wound so a physical barrier ter to keratinocytes and fiberblast entering that wound at the edges and trying to get that to heal by laying down new collagen and re epithelializing the wound now if we don't have the free movement of keratinocytes and fiberblast then wound healing is going to be impaired and delayed so we want to avoid scabs because of this physical barrier it creates next the scab is essentially a dry environment okay so it's dried out blood dried out exate creates that physical barrier and it prevents autolytic debent by healing cells such as neutrophils and macroasia another reason and I sort of touched on this is that scabs can promote prolonged inflammation so if a scab is built up debris built up dead tissue even built up bacteria that is going to cause increased cyto kindes that we don't want so interlan one interlan 6 tnf Alpha and those are pro-inflammatory and they are going to impair the wound healing process another reason scars are bad is that it impairs the development of granulation tissue so granulation tissue is basically new blood vessels this is angiogenesis that is providing blood blood and getting those fiber blasts into the wound and if we have a scab we are going to prevent that granulation tissue from forming you know finally scabs can worsen scarring as we talked about and also increases the risk of wound disruption so if we have a scab and then we have trauma and that scab breaks open then now we're introducing new bacteria into the wound and increase traum to the wound which is going to impair wound so how do we prevent scabs will we prevent SCS by maintaining a moist environment and there are a bunch of different dressings that you can use and I'm going to show a couple of those here so we can just use Band-Aids another one is MEC so a nice silicone for foam dressing can stay on a wound for up to seven days it can also manage the exit dat and if you haven't seen my video on the wound dressings and sort of the all the different types of dressings I would definitely recommend checking that out we can also use a transparent film dressing and when we in the next myth I'm going to actually talk about what dressing can you use if you have a scab and what do you do if you have a scab and that brings me to the next myth and what is the next myth the next myth is that removing a scab is a good idea well let's bust that because removing a scab is a bad idea all right we don't want to pick that scab off because now we're introducing bacteria we're traumatizing the wound we're going to impair that wound bed but what do we do if we get a scab what do we do if we listened and we said we're going to let that wound breathe and now we have built up blood exate sard dead skin cells a dry scab what should we do what should we what do you think well I'm going to tell you so if we have that that is a sign that we have dry wound bed and we need to rehydrate the wound now we can do that with some specific dressings and the ones here I would say would be your hydrogel dressings so hydrogel dressings are excellent in superficial Burns they're great in abrasions they're also good if we have scabs and that's going to rehydrate that wound bed and allow the body to do its autolytic de bment with the cells in the body moist ize that wound bed and get it in a positive healing Direction you know also if we have a scab and we have this dressing before that we want to keep the area clean and moisturized uh gently irrigating and gently debring the wound that just could mean just rubbing the room gently with clean soapy water and rinsing that clean and then applying a moisturizing dressing another thing that can help is applying a moisturizing ointment like a p petroleum jelly that will also protect the wound and allow it to maintain its moisture that moisturizing oil is going to prevent tearing prevent cracking and reduce the trauma to the wound and sort of rehydrate that wound so we can get optimal healing now in all wounds and especially if we have a scab on there we want to Monitor and we want to be aware of signs of infection so if we have increasing redness or increasing athema if we have increasing edema and swelling if we have increasing pain if we have any purulent discharge or pus coming out of the wound and that is really concerning for an infection we want to visit our health care professional for management of that but as I've said in this talk and in my wound healing videos maintaining a moist environment will eliminate the scab formation prevent scab formation and create this optimal wound bed for proper healing so let's get to the next myth myth number five that is antibiotic ointments are needed for optimal wound healing well that myth is just not true so antibiotic ointments for example neomy polymixin B Bacitracin these are a petroleum jelly ointment that is impregnated or includes an anti biotic they have advantages and disadvantages they can be good for some wounds and they can actually be harmful well what is the number re one reason why antibiotic ointments can be harmful well there's a few reasons but the first is that they can lead to contct dermatitis so there is approximately 10% of the population that is allergic to polymix and B and that is a very common antibiotic in in antibiotic ointments and so if you place that odd and you're allergic then you can get contact dermatitis and that inflammation can impair wound healing and prolong wound healing all right so what are some of the advantages of antibiotic ointments the idea behind an antibiotic ointment is that they will prevent infection in superficial wounds so for example infection by bacteria such as staic cacus or strepto cacus which is colonized all over our body and when we as a have a disruption in our protective Skin Barrier by a scrape or a cut then that stacus or strepto cacus uh and other bacteria of course can enter that wound bed and cause an infection and so antibiotic ointments are aimed at preventing that infection well when should you use an antibiotic or when could you use an antibiotic orament and when should you avoid it now before we get there one thing I want to say is as we've talked about probably the most important advantage of an antibiotic equipment is the ointment part so the petroleum jelly creates that moist wound environment okay and so that's really the main advantage much more than the antibiotic portion of an antibiotic ointment another disadvantage in antibiotic women is the growing risk of antibiotic resistance so it may seem rather innocuous to use neosporin or neomy or polymixin B bitrain onto a a wound to get it to heal but over time we can develop antibiotic resistance in our communities by constantly exposing bacteria to antibiotics so that they can develop these mechanisms like methylin resistant staf Cocos orus so one reason that we don't want to use antibiotic oil ments generally on all wounds is that you can have contact dermatitis that can impair wounding another one is the development antibiotic resistance so as I was alluding to what are good candidates if you wanted to use a antibiotic ointment well those would be minor Cuts minor scrapes with a higher risk of infection so a scrape out at the playground perhaps for that first day or two we want to use at antibiotic ointment uh but in cleaning wounds especially clean surgical wounds that have been closed in a sterile environment there is no evidence that antibiotic ointments are helpful if we have deep wounds or deep lacerations antibiotic ointments canot can build up and form a barrier to wound healing so in deep wounds though antibiotic ointments are also a bad idea so finally in my opinion minor scrapes minor abrasions antibiotic ointments can be helpful in wounds that have a higher risk of infection however for the most part just a simple moisturizing dressing with a petroleum jelly to keep that moist wound bed in an optimal healing environment is all that you need but of course contact your health professional for kind of official recommendations if you do have a wound that you're worried about let's get on to the next myth and that's myth number six and myth number six is that scarring means poor healing well that's just not true so when we disrupt the epithelial barrier there is a risk that we get a scar and what is a scar well when we go through the different phases of healing the Final Phase Remodeling and the third phase when we are getting collagen deposition when that collagen is laid down that result is a scar and they can be normal and they can also be abnormal so if we have hypertrophic scarring or even choid scarring where the collagen extends outside the wound bed those are abnormal scars but most of the time when we disrupt that epithelial barrier we are going to end up with a scar well how do we minimize scar formation and I'm going to take you through a few different types of wounds and how we can minimize scar formation well why do scars form scars form from coll lay down and scarring can be worse if we have poor or delayed wound healing okay so Sr formation scabs repeated trauma by pulling off a scab those things are going to increase scar formation we can also increase scar formation if we have too much tension over a wound okay so let's go through a few different wounds and how can we decrease our chance of scarring so first our superficial wounds so minor cuts abrasions how can we help and prevent scar there well first is just to create an optimal healing environment use a petroleum jelly use a silicon based uh foam dressing like a Mex or even a Band-Aid if it's very small um those things are also going to decrease UV exposure to the wound okay and UV exposure can darken a wound and worsen the pigmentation of a scar okay why does that happen well melanocytes those are cells in the skin that give skin its pigment are attracted to wounds most likely from TGF beta uh msh milanisti stimulating hormone these attract melanocytes to a wound and can lead to increased pigmentation so if we can keep the wound covered with a moisturizing dressing like some of the ones I mentioned before and I put those in the description below that can help optimize wound healing and decrease scar formation well how about surgical wounds so surgical wounds we can decrease scar formation a couple of ways number one is by appropriate opposition of the wound edges okay that's really up to the surgeon okay second is making sure that we have reduced tension across the wound so in high tension wounds I'll apply stary strips across the wound which will take the tension off those opposed edges often if I have to place sutures in wound after I take sutures out I'll Place ster strips across the wound to decrease tension on that wound also applying a silicon bandage or a hydrogel sheet uh a transparent film dressing can help create a moist environment on that wound and decrease the risk of scar formation during the remodeling phase so that's going to be you know six weeks to a couple years after a wound is uh healed then of course gently massaging wound can also decrease the risk of scar formation well how about in Burns when we have superficial Burns first deegree Burns second degree burns those are the ones that are going to lead to blistering when we have those you obviously you want to listen to a healthc care professional but silicone sheets hydril jings can create that moist environment to optimize wound healing and decrease the risk of scar formation another serious wound are lacerations so what is a laceration well a cut and a scrape are basically confined to the epidermis and the dermis but if we go through the dermis and down below that into the fatty layer well that is a laceration and those usually require apposition uh by with sutures or you know butterfly dressings or stere strips so we can get that wound after it's been cleaned de breeded and we have a nice sterile environment closing those edges so we can get proper healing if we have a laceration that's left with opposed edges then we have a risk of poor wound healing and significant scar formation another type of wound be a puncture wound so a puncture wound with a nail or something it can be a deep but very narrow wound now the problem with those is you have an increased risk of infection so it's very important to monitor for infection in these wounds but again a moist environment can help decrease scar formation then finally our tension prone wounds so if you have a wound that's across the joint or in an area where there is not a lot of skin elasticity so for example on the medial anterior aspect of the lower leg okay across the shin bone well those are high tension wounds and have an increased risk of scarring so how do we decrease scarring well we can you know surgically maybe you do a z plasty that could be more tension free uh closure but if we close the skin and pose the edges again ster strips across that wound uh can help take tension off those edges and lead to better healing and as I mentioned before after the wound is healed some gentle scar massage can decrease the risk of that scar forming and finally let's get to that final myth and that's myth number seven swimming with a wound is okay well again that's a myth and swimming with a wound is not okay and I'm going to give you the reasons that it's not okay all right so when we swim with a wound whether that's in a swimming pool whether we're in a river whether we're in a lake whether we're in the ocean there are microorganisms and bacterias in swimming pools specifically pomonis orinsa and other bacteria that get into that wound bed and can cause inflammation and infection in fact there's a good study I can put it in the description below that swimming with with an open wound is one of the major causes of wound infections so whether it's fresh water swimming pool or the ocean it's generally a bad idea we're not talking just about infection but when we have an open wound and we go swimming we can merate that wound and we're going to impair all the cells in that healing wound bed there's a good study in the Journal of wound repair and regeneration that those healing cells are disrupted both from the trauma associated with wound and with the water damaging those healing cells when we're talking about swimming pools remember swimming pools are going to have chlorine and bromine in them which are disinfectants well disinfectants are great when we want to get rid of bacteria in the pool but remember chlorine and bromine it's going to kill not only bacteria but healing cells and that's going to disrupt the wound bed it's certainly not doing you any favors to have chlorine in a healing wound so it's generally recommended that we avoid swimming in submerging wounds until they are fully healed or covering them with a waterproof dressing and a waterproof dressing could be like a hydroc coloid dressing or a silicon boast dressing or a transparent film dressing these are some options for waterproof dressings to protect that wound but certainly we do not want to submerge an open wound in a swimming pool a lake or a ocean now sometimes for example with pylon idal disease when I do a a procedure where I excise that pidal disease and those pits and all the tracks and de breed it I will have a patient sit in a bath a sits bath with some soapy water and that's going to help to breathe the wound keep it moist and clean and that's really important when we want to facilitate wound healing in complex wounds all right so today we talked about seven big myths with wound healing we went through why we don't want to let wounds breathe that's the big one and we keep coming back to that we don't want to dry a wound out and dehydrate it you know second we talked about alcohol and hydrogen peroxide and how they can damage the wound bed in a number of ways not only because they're disinfectants and going to kill the bacteria as well as the healing cells but they also dehydrate the wound and cause increased oxidative stress we talked about scals and why we don't want scabs to form by maintaining a moist environment back to number one and if we do have a scab instead of picking it off and tearing it we want to use a moisturizing dressing to create that optimal environment we talked about antibiotic ointments we talked about how to limit scarring and of course we talked about not submerging a wound in a swimming pool lake an ocean River or anywhere else you may want to cool off until that wound heals so I hope you enjoyed that today if you did enjoy it I would direct you perhaps check out that video I made on the best dressings for wound healing I go through wound healing and I go through you know simple dressings and more complex ones I even talk about our silver alinat and different collagen dressings that can improve complex wounds or you can check out my video on wound healing 101 and that's where I go through all these phases of wound healing and I'll put those right up there so you can check it out so if you like this video make sure to give it a like turn on the notifications so you're going to know when I put out these videos and you can be the first to watch them of course if you can share it with your friends that's going to show me that I am providing value to you and uh like And subscribe to the channel I'd love you'd be a member of our community if you have a question or comment leave it below I love engaging with you and as always stay safe study hard I'll see you next time