Part 2 in my modern wound care series. See part 1, on the latest advice for cleaning a wound, here.

How to dress a wound to better promote healing and prevent infection.



by James Hubbard, MD, MPH

How many cuts and scrapes have you gotten in your life? Probably quite a few. Yet, to this day, do you know whether it’s better to keep a wound covered or let it air out?

Simple wound-care questions like that have left even doctors debating the answers. So earlier this year, an article in American Family Physician, the journal of the American Academy of Family Physicians, offered some answers. For the article, three researchers from Thomas Jefferson University looked at a number of studies on wound care and formulated guidelines based on the findings. Here are some highlights.

1. Can I get my stitches wet?

It turns out getting your stitches wet is not as big a deal as we once thought. In one study cited in the article, people who got their sutured wounds wet within 12 hours had no more infections than people who kept their wounds dry for 48 hours. In another study, washing a wound within 24 hours didn’t result in infection or the stitches tearing open.

But I think the studies left out a couple of variables. I think it’s more how the wound gets wet that matters. Good, clean water may be fine, but I would definitely avoid contaminating it with dirty water. For instance, taking a bath or shower and patting the wound dry afterwards may well be okay, but not swimming in a lake.

The other variable is how long you can keep it wet. Even with these studies, I’d be hesitant keep it soaking wet for more than a very few minutes because the sutures could tear.

2. Should I air the wound out?

Basically, the studies indicate wounds heal faster if they stay slightly wet in their own tissue fluids. Drying causes scabbing and dehydration of the tissue cells, which delays healing slightly.

But be sure to know that what they’re referring to here is the actual wound and not the uninjured tissue around it. In my opinion, you should try to keep the uninjured skin dry so it won’t macerate (soften) so much the sutures may tear.

So, to me, yes, it’s a good idea to keep the wound moist enough that a big scab won’t form, but airing it out for a few minutes might keep the uninjured areas dry.

I don’t really see drying out a wound as much of a problem in a nicely sutured, non-oozing wound. I think the tissue fluids come more into play with large wounds and scrapes, and particularly with deep burns. In any of those, you might cover the actual wound with a nonstick dressing, customizing it to the size of the wound. Then put a layer of gauze that’s not moisture proof on top. Then tape.

If the dressing gets wet externally, change it since this outside moisture may macerate the uninjured skin. Even if the dressing stays dry, change it once a day so you can check on the wound for signs of infection.

Of course, one other purpose of the dressing is to protect the injured area and keep it clean.

3. Should I always use antibiotic ointment?

The review found evidence that over-the-counter antibacterial ointments may prevent infection, especially in wounds that you deem a bit dirty (even if you’ve cleaned them well). However, the incidence of infection is pretty low in wounds caused by a clean cut that are not too deep, whether you use ointment or not.

What’s been your experience?

This has been part 2 in my modern wound care series. Click here for part 1, “Advanced Wound Cleaning: Beyond the Paper Cut.”