Dr Rotimi Aderibigbe, a wound care specialist and consultant plastic surgeon at University College Hospital (UCH), Ibadan, in this interview by SADE OGUNTOLA, speaks on wounds, healing process, complications as a result of wrong dressing materials and implications for conditions such as low blood supply, diabetes and sickle cell disease.
WOUNDS can happen in different parts of the body, but are all wounds the same?
Wounds can happen in every part of the body, including inside the body. Once there is discontinuation in the covering, be it on the skin, which is the covering of the body we see outside, or on the inner surfaces, it can result into a wound.
Wounds are so common that many people pay little attention to them or their care. The causes are enormous, producing various sizes and extents. Particularly in our environment, causes of wounds include physical injury from different reasons, like a road accident, a knife cut, stepping on a nail, a fall, and burns from hot water or a gas explosion. Wounds can also develop when there is a lack of blood supply to areas of the body, such as in cancer and other conditions like diabetes, sickle cell disease and infection.
Often times, an individual may not know the cause of a wound or how severe it could become. However, medical personnel will do this easily, including any possible problems that may make the wound not heal as soon as possible. Many problems may occur after a wound becomes infected. That is why all wounds should not be taken lightly, because they are not the same.
For instance, a wound in a person with diabetes whose blood sugar is not well controlled will not heal, and infection can easily set in. Such an infection invariably goes into the body, causing more problems, even for the diabetic individual. It becomes a cycle. In fact, if a diabetic has an infected wound, it becomes difficult to even control the sugar. So, taking good care of the wound is important for good blood sugar control.
Are chronic wounds a problem in Nigeria?
Wounds can be acute or chronic; now the difference between the two is in terms of the time it took for the healing of the injury. Wounds are expected to heal within four to six weeks. Wounds that fail to heal within that specific period are termed chronic wounds, while those that heal within this period are termed acute wounds. Once a wound is not healing, something within the body is preventing the natural healing process, which is one of the things doctors will look out for.
Factors that make wounds not to heal fast include a persistent condition like diabetes, sickle cell disease, poor nutrition, anaemia, chronic diseases of the body like kidney or heart failure, chronic cough and blood vessel problems. For instance, if a wound is sustained on a leg with a reduced blood supply, its healing will take a longer time. Cancer can cause some parts of the skin to become wounds. If you continue to dress the wound from now to eternity, that wound will not heal because it was caused by a malignancy.
Wound care is of public importance because everybody has sustained a wound before, no matter how small it may be. The majority of these wounds will heal without any problem, but some are quite unfortunate that they will not heal. Such a person initially may not seek appropriate medical attention. Rather, they seek help from chemists, some of whom are traditional healers. But after having the wound for quite some time, they discover that it is not healing, and so they move from one doctor to the other, nursing that wound. In the process, they lose money, time and social support. Due to the bad smell from the wound, people move away from them, families break up, and some are sent out of work.
So, are there wound care practices that should be discouraged?
Wounds are not all the same; every wound needs to be assessed to identify what the problem is and attend to it as required. Locally, it is common practice to apply to the wound such things as Gentian violent, raw pap (ogi), shea butter, kerosene, antibiotic power, hydrogen peroxide, petrol, iodine solution and methylated spirit. I will not say all these things are bad, but in a lot of ways, they are not rightly used as a wound care agent.
Putting antibiotic powder on a wound is not ideal, and sometimes putting methylated spirit on a wound is also not good. Methylated spirit, for example, may be toxic, causing injury to small cells just developing within the wound. That is not to say that methylated spirit cannot be used to clean the skin around the wound, but not to pour it directly on the wound.
Applying antibiotic powder to the wound will make its surface cake. People assume that once the wound looks dry on the surface, it has healed. But the truth is that if the dry crust is removed, you will see the true nature of the wound. The wound is still there, and the dry crust does not allow the wound to heal from the edges, which is where the healing comes from. So, it ends up increasing the healing time. Its use needs to be discouraged.
Hydrogen peroxide and eusol are also common agents used for wound dressing, particularly in controlling those initial infections in dirty wounds that are very smelly or bad. Most of the time, we discourage the use of hydrogen peroxide in wounds that are not dirty. It is toxic and can delay healing overall in clean wounds.
If the wound is chronic, these substances will not help support healing. It will cause more problems. So it will be most appropriate to look for a doctor who can take care of the wound effectively. A lot of people are engaged in wound care, but not all of them are professionals trained on how to handle wounds. Once a wound is sustained, even if it is a small cut, don’t pour anything on the wound; just seek medical advice. I’m sure doctors know what to do.
What about the use of saliva, a practice many children do in wound care?
Saliva cannot be an agent for dressing wounds. Saliva contains a lot of microorganisms and when you put it on the wound, you can bet that all those microorganisms are going to grow within the wound and cause more problems, so it should be discouraged. Children should be advised not to do such things.
What about tetanus injection after sustaining a wound?
Tetanus injection in wound care is very important. But it is only a medical doctor who will know the category of people who will require a tetanus injection after sustaining an injury. It is not necessarily everybody who must get a tetanus injection every time they sustain a wound.
Are there home remedies that you will support for wound care to ensure fast healing?
I am not aware of any remedy that ensures fast wound healing. People mention honey and leaf extracts, but it goes back to the fact that wounds are never the same. The mere fact that you have a tiny wound does not mean that you don’t have any problems that can make that wound worse. It is important to identify those important factors and then treat them appropriately.
That Mr A sustained a tiny wound on the hand and, luckily for him, there are no systemic problems or other issues; the wound may heal by itself. He may have applied honey and some other home remedies and assumed that these remedies helped the healing process. But that may not be the case with Mr B, a diabetic who also sustained a small wound and then continues to apply all these home remedies. You can bet, the outcome will not be the same. There are lots of things that we do in the hospital, particularly those who pay attention to wound care, which is beyond just seeing the wound. We treat the person as a whole, not the hole. The wound is not seen as just a hole.
What are the challenges faced in treating unhealing or chronic wounds in Nigeria?
It is sad when sometimes I receive referrals from people who say that they have had the wound for many years, some 10 to 15 years. One will wonder where they have been. There is very little public awareness about how to properly take care of wounds generally. Also, in a way, there is less training for medical personnel because a lot of them don’t pay too much attention to wound care. If a health worker has been seeing a patient with a wound for quite some time and the wound is not healing, I think the physician needs to sit back, ask why this is so and if there is a need, refer the patient appropriately and promptly.
What is the cost of the wound to the patient?
The cost of care is an issue; it eats so much into their finances. Let’s say the cost of care at this point is N500. Now, if these have to be done for months, you can imagine how much that will translate to, overall. It is a major concern. Also, the cost of going to the health facility to do dressing and the man hours lost while away for wound dressing are unseen costs. So it is a big financial burden for those with chronic wounds.
There is no restriction to going to the hospital to have a wound dressed appropriately, but going to the right hospital is the question. How do you know where to go? It is a bit difficult. But any hospital should be able to manage the wound appropriately and refer if the wound is not healing.
Are there basic rules mothers must know regarding the proper handling of wounds in children?
While it is important to have the first aid kits, depending on what caused the wound, take the patient away from what has caused the wound; if the wound is bleeding, apply clean covering and move to the hospital. I am aware that a lot of mothers keep many things at home as first aid, like penicillin ointment, methylated spirit, Gentian violent, and so on. Please ensure that you get the person to the hospital, irrespective of whatever might have happened. The cost may be extensive, but get proper advice. Let them alleviate your worry that the wound is going to heal in no time.
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