Everyone receives wounds over the course of their lifetime. A wound is a
break in the structure of an organ or tissue caused by an external agent. Most
wounds affect the skin, the first line of defense against infection. Commonly
recognized examples include bruises, grazes, tears, cuts, punctures (made by
pointed objects), incisions (clean cuts), contusions (may not break the skin but
can cause damage), lacerations (jagged, irregular cuts), and burns. While some
wounds heal easily, approximately five million Americans suffer from chronic
open sores that can become seriously infected.
|Signs and Symptoms|
Wounds are often accompanied by the following signs and
- Abnormal flushing of the skin
- Swelling as a result of the accumulation of fluid in body
- Pain and tenderness
- Possible fever with infection
- Bleeding or oozing pus
- Loss of function (or mobility)
- Foul smell (in infected wounds
|What Causes It?|
Wounds can be caused by any of the following.
- Blunt or penetrating trauma
- Chemical injury
- Thermal injury
- Temperature extremes (e.g., burns, frostbite)
|Who's Most At Risk?|
The following risk factors are associated with wounds.
- Age (older people are at higher risk)
- Malnourishment, especially protein depletion
- Trace element deficiencies, especially zinc
- Vitamin deficiencies, especially vitamin C
- Compromised general health
- Steroid use
- Radiation and chemotherapy
- Weight loss or obesity
|What to Expect at Your Provider's Office|
If you receive a serious wound, you should see your health care provider.
Your provider will determine the extent and severity of the injury, possible
contamination, and conditions that might complicate treatment. He or she may
also order laboratory tests, such as a blood test and urinalysis, as well as a
culture to check for bacteria in the wound. Your provider may also suggest you
get a tetanus vaccine.
Most wounds are accidental and often preventable. Once you've received a
wound, infection and other complications can be prevented by carefully cleaning
the wound and using antibiotics as needed.
Treatment depends on the type and severity of the wound. Some wounds, such as
clean lacerations, are relatively minor and can be treated at home. Clean the
wound with a gentle cleanser and stop the bleeding, then cover with an adhesive
bandage. Other wounds, particularly those where the bleeding will not stop, or
any wounds resulting from animal or human bites or fishhook injuries (do not
remove the hook) can be serious and must be treated by a health care
professional. Some wounds may involve a loss of tissue and require a skin graft,
where a piece of skin is cut from a healthy part of the body and used to heal
the damaged area. Your health care provider will determine whether the wound can
be closed immediately, by suturing or grafting, or whether it must be kept open
because of contamination. Infected wounds are never closed until the wound has
been successfully treated.
Your provider may prescribe the following medications:
- Analgesics, or pain relievers
- Antiseptics, to clean contaminated wounds
- Antibiotics for infections or sepsis (destruction of tissues by
disease-causing bacteria, accompanied by a strong odor)
- Medicated dressings
- Corticosteroid hormones
- Tetanus shots
- Growth factors (substances that stimulate
|Surgical and Other Procedures|
In the case of severe wounds, surgery is sometimes needed. This may involve
cutting out burned tissue and removing contaminated tissue, skin grafting, and
draining wound abscesses (pus surrounded by inflamed
|Complementary and Alternative Therapies|
A comprehensive treatment plan for wounds may include a range of
complementary and alternative therapies.
Potentially beneficial nutrient supplements include those listed below. These
supplements can also be taken before surgery to reduce healing time. Lower dose
or stop use when wound has healed.
- Beta-carotene (250,000 IU a day) or vitamin A (50,000 IU a day) to
promote healthy scar tissue. These are high doses and should not be taken for
longer than one to two weeks without your provider's supervision. Reduce dose to
50,000 IU of beta-carotene and 15,000 to 25,000 IU of vitamin A daily after two
weeks. Do not take vitamin A if you are pregnant or trying to
- Vitamin C (250 to 500 mg twice per day) enhances tissue formation and
- Vitamin E (400 to 800 IU a day) promotes healing. May be used
externally once the acute phase has passed and new skin has formed. Higher doses
may be beneficial for healing burns.
- Zinc (10 to 30 mg a day) stimulates wound healing.
- Bromelain (250 mg three times a day between meals) reduces
post-surgical swelling, bruising, healing time, and pain.
Certain herbal remedies may offer relief from symptoms.
- Turmeric (Curcuma longa) is an anti-inflammatory that enhances
use of bromelain. Use dried extract 250 to 500 mg three times a day.
- Gotu kola (Centella asiatica) promotes connective tissue
repair, supports normal wound healing, and prevents a scar from growing larger.
Use standardized extract 60 mg one to two times daily, or 60 drops of tincture
three to four times per day. It may also be applied topically to burns to
minimize skin shrinking. Note that gotu kola can cause sleeplessness and anxiety
in some people. Reduce the dose if this happens.
- Coneflower (Echinacea purpurea) and goldenseal (Hydrastis
canadensis) used together protect against infection. Use equal parts
tincture 30 to 60 drops three to four times a day.
- Powders of goldenseal, comfrey (Symphytum officinale), and
marshmallow root (Althea officinalis) enhance healing and minimize
infection. Apply to the skin surface. Washes or compresses of cooled tea
containing these herbs may also be used.
- St. John's wort (Hypericum perforatum) oil helps prevent
post-surgical adhesions and may relieve nerve pain. Apply to the
- Aloe vera gel provides excellent pain relief and speeds healing. Apply
to burns and wounds.
- Marigold (Calendula officinalis) and plantain (Plantago
major) aid in healing. Can be used on the skin as salves or creams. These
herbs should only be used on incisions or "clean" wounds. Due to their fast
action, they could keep an infection from healing.
- Granulated or confectioner's sugar applied to the skin can help heal
skin ulcers, such as those caused by diabetes or bed
Herbs are generally available as dried extracts (pills, capsules, or
tablets), teas, or tinctures (alcohol extraction, unless otherwise noted). Dose
for teas is 1 heaping tsp./cup water steeped for 10 minutes (roots need 20
Some of the most common acute remedies for wounds are listed
- Arnica for bruised feeling and grief and/or shock from
- Staphysagria for pain from lacerations or surgical
- Symphytum for wounds which penetrate to and involve
- Ledum for puncture wounds
- Urtica for burns
- Hypericum for injuries and trauma to nerves
- Wala for
Prognosis depends on the extent and severity of the initial wound, as well as
any subsequent infection. There are several complications associated with
wounds: infection; keloid scar tissue formation (an overgrowth of scar tissue
that can be deforming); gangrene (which may require amputation); wound
hemorrhage; sepsis; and tetanus (a potentially fatal infection of the nervous
Check for signs of bleeding, discoloration, or swelling in and around the
wound. Inform your provider if you experience fever, increasing pain, and the
development of drainage, which may indicate an infection.
Black JM, Matassarin-Jacobs E. Medical-Surgical Nursing: Clinical
Management for Continuity of Care. 5th ed. Philadelphia, Pa: W.B. Saunders
Blumenthal M, ed. The Complete German Commission E Monographs. Boston,
Mass: Integrative Medicine Communications; 1998:432.
Carr AC, Frei B. Toward a new recommended dietary allowance for vitamin C
based on antioxidant and health effects in humans. Am J Clin Nutr.
Fauci AS, Braunwald E, Isselbacher KJ, et al, eds. Harrison's Principles
of Internal Medicine. 14th ed. New York, NY: McGraw-Hill; 1998:837, 839,
902-905, 947, 968.
Hardy JD, et al. Hardy's Textbook of Surgery. 2nd ed. Philadelphia,
Pa: J.B. Lippincott; 1988.
JAMA Patient Page. How much vitamin C do you need? JAMA.
Johnston CS. Recommendations for vitamin C intake. JAMA.
Kruzel T. The Homeopathic Emergency Guide. Berkeley, Calif: North
Atlantic Books; 1992:312, 314, 316.
Levine M, Rumsey SC, Daruwala R, Park JB, Wang Y. Criteria and
recommendations for vitamin C intake. JAMA. 1999;281(15):1415-1453.
Murray MT. The Healing Power of Herbs. Rocklin, Calif: Prima
Publishing; 1991:184, 185, 207.
Nettina SM. The Lippincott Manual of Nursing Practice. 6th ed.
Philadelphia, PA: J.B. Lippincott; 1996:90-91.
Reeves CJ, et al. Medical-Surgical Nursing. New York, NY: McGraw-Hill;
1999:535, 542-546, 551-553, 567-568.
Schwartz SI, et al. Principles of Surgery. 5th ed. New York, NY:
McGraw-Hill; 1989:201-205, 301-302, 320-323, 470-473.
Thompson JM, et al. Mosby's Clinical Nursing. 4th ed. St. Louis, Mo:
Mosby; 1997:461-462, 1099-1100, 1160, 1441.
|Review Date: March 2000|
|Reviewed By: Participants in the review process include: Shiva Barton, ND, Wellspace,
Cambridge, MA; Peter Hinderberger, MD, PhD, Ruscombe Mansion Community Health
Center, Baltimore, MD.|
Copyright © 2004 A.D.A.M., Inc
The publisher does not accept any responsibility for the accuracy of
the information or the consequences arising from the application, use, or misuse
of any of the information contained herein, including any injury and/or damage
to any person or property as a matter of product liability, negligence, or
otherwise. No warranty, expressed or implied, is made in regard to the contents
of this material. No claims or endorsements are made for any drugs or compounds
currently marketed or in investigative use. This material is not intended as a
guide to self-medication. The reader is advised to discuss the information
provided here with a doctor, pharmacist, nurse, or other authorized healthcare
practitioner and to check product information (including package inserts)
regarding dosage, precautions, warnings, interactions, and contraindications
before administering any drug, herb, or supplement discussed