Wound care
Closed wounds: After surgery, you will be instructed to leave the surgical dressing on for a certain period of time. Once you are allowed to remove the surgical dressing, you will begin changing the dressing once a day until the wound is no longer oozing and is no longer tender to the touch. Unless you have been instructed otherwise, once you begin dressing changes, you can remove the old dressing and get the wound wet in the shower once a day. In the shower, you can let the water run over the wound and gently cleanse it with soap and water. After the shower, you can pat the wound dry and apply a new, clean dressing. Ointments or salves are not needed. Do not immerse the wound in unclean water such as bath water, pool water, lake water, or dishwater until the wound is completely sealed up. A bandaid with a self-adhesive wrap (e.g. one or two inch 3M Coban wrap) placed over the top makes an excellent dressing in most cases.
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Open wounds: The body has a remarkable capacity to heal even large open wounds. Keeping the wound bed moist is critical to the healing process. If the tissues dry out, they will become unhealthy and die. For most clean open wounds, Dr. Williams will advise daily dressing changes. Unless you have been instructed otherwise, you can remove the old dressing and get the wound wet in the shower once a day. After the shower, pat the wound dry and then apply a thick layer of Vaseline or Aquaphor Healing Ointment to the open area. The greasy ointment will keep the wound moist. Then place self-adhesive wrap (e.g. one or two inch 3M Coban wrap) directly atop the Vaseline or Aquaphor.
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Soaks: If you have an infected open wound, Dr. Williams may recommend soaks. You will need a basin or bowl in which to soak your hand and a fragrance-free antibacterial liquid soap such a Dial. Fill the cup, basin, or bowl with warm water. Then add 3 pumps of the antibacterial soap into the water. Soak your hand for 20 minutes in the warm soapy water. To help prevent stiffness, gently flex and extend your fingers as best you can while soaking. After 20 minutes, rinse off your hand, pat it dry, and apply a new clean dressing as above. You may be instructed to place a petroleum dressing (such as Xeroform or Adaptic) and gauze atop the Vaseline or Aquaphor before applying the self-adhesive wrap.
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Scar care: Scars may take 12-18 months to fully "mature". The following measures are recommended to help minimize scar formation:
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· Sun protection: Protect the scar from sun exposure for at least the first year. This can be done by covering the scar or by using sunscreen with a SPF rating of at least 30.
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· Scar massage: Once the wound is sealed and you have been cleared by Dr. Williams or your hand therapist, you may apply Vaseline or Aquaphor to the scar and gently massage it for a few minutes, 3-4 times a day, to aid in scar tissue breakdown. In addition to assisting with scar massage, the Vaseline/Aquaphor will keep the scar moist, which is also beneficial.
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· Silicone gel sheeting: Once the wound has sealed, silicone gel sheets can be applied at night and, if convenient, during the day. These may help improve the appearance of the scar over time. They are available from our hand therapists, online, and at some drugstores.
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· Vitamin E: Dr. Williams does not recommend vitamin E. Studies have shown that it is of no benefit in improving the cosmetic appearance of scars, and it may cause skin irritation.
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For more troublesome scarring that does not respond to these measures, other treatments are available. Dr. Williams can discuss these with you at greater length.
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Red flags: If you have increasing redness, swelling, pain, or drainage from your wound or any other concerns, please call Dr. Williams' office right away.
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Dr. Williams is indebted to Dr. Don Lalonde for his excellent teachings on wound care and has found the following article to be an excellent resource:
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Lalonde D et al. Simple effective ways to care for skin wounds and incisions. PRS Global Open 7(10): e2471.
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