Keeping the Wound Clean
Cleaning and wound hygiene is important in both closed and open healing, although in open healing it becomes a critical part of daily care.
- Closed Incision: You should avoid getting the area wet for the first 24 hours. After that, you can wash the area gently once or twice daily. It is better not to use deodorant soaps or heavily fragranced soaps. It would also be best to avoid soaps with moisturizers mixed in. We strongly suggest that one of two soaps be considered for closed incision cleaning: either Cetaphil or Hibiclens. Both should be available at most any drug store in the US, there are likely comparable products in other countries, just ask your drug store pharmacy. After washing, pat gently dry with a towel and apply dressing as normal. Closed incisions require no further cleaning.
- Open Healing: One of the cornerstones of open healing is frequent cleansing out of the wound bed. It is critical to flush out the wound with water or saline and change the dressing at least twice a day until only the top 1/4" is left to heal. My surgeon recommended three (3) times a day for the first month of healing but other doctors have recommended twice (x2) a day so it's your call - both ways work. Even the professional wound care people are split between how often packing changes are necessary - the only consensus is that twice a day is a minimum. If you are in a position where you can do 3 times, it certainly won't hurt.
The best way to cleanse your wound is in the shower, using a hand held sprayer to gently flush out the inside of the wound. Some people have also used a squirt bottle in place of a sprayer, whatever works for you (and is sanitary) to irrigate the wound bed and flush out the Exudate is ok. You do not need to use any kind of soap inside the wound. Don't worry if the wound bleeds a little bit, this is actually good and bleeding helps the wound clean itself. Large amounts of blood would be a reason to contact your doctor. Bleeding that does not stop after a couple of minutes is a reason to head to the ER.
Another option is to use Saline Solution to flush out the wound. You can take sitz baths with Epsom Salts, but be sure to still flush the wound out afterward. Some doctors have told the patients not to take baths at all, thinking that soaking in your own germs in not a very good idea. It is our opinion that soaking is fine with Epsom Salts since salt has natural antibacterial properties. Salt bonds with the moisture in skin to create a barrier against germs. Salt also reduces inflammation, itching, and increases blood circulation.
Some surgeons have had patients clean open healing wound areas with Hibiclense.This product is a well studied antibacterial (your surgeon probably scrubbed with it prior to surgery) but should be used sparingly and not inside the wound unless specifiacally directed by your doctor. It does do an excellent job of getting the areas of the rest of the natal cleft clean and reducing bacteria, which can effect your healing wound.
What you should NOT use is Alcohol or Hydrogen Peroxide. You can use either of them (diluted at 50%) for an occasional cleaning but both of these products are too harsh for daily use in healing wounds. Hydrogen Peroxide was once used for these types of wounds for its debriding ability, however, since about 1996 the course has changed and wound care specialists have come to realize that too much tissue damage occurs to healthy cells that are needed for wound healing when Hydrogen Peroxide is used. HP is considered "cytotoxic", meaning deadly to cells, thus it actually inhibits wound healing. Unfortunately, many doctors and nurses and are not informed that HP is no longer recommended for wound healing and they give their patients instructions that actually SLOW DOWN the healing process.
The High-Tech World of Wound Cleansers:
Under normal circumstances, an open healing wound needs only water or saline for basic cleaning. If healing is not happening at the expected rate, that would be when you might consider bringing in the big guns and giving your body a helping hand in getting that wound closed.
There are a number of high-tech wound cleaning products out there, these tend to be very expensive (but covered by insurance if your doctor prescribes them) and usually only used by Wound Care Centers. Don't automatically assume you need a high-tech wound cleanser, these products generally should be used in conjunction with healing problems under the care of a Wound Center.
There are two major classifications of wound cleansers at the high end:
Healing Enhancers - Many of these products are Zinc based and will help with both moisture and nourishing new tissue formation. You might consider these to help speed up healing that seems to have stalled.
Antimicrobials - These products work by killing or inhibiting the growth of bacteria, fungi and other nasty things. These would normally be used after a culture of the wound tissue indicated that bacteria was entering the wound and delaying healing.
A great list of products can be found at WoundSource.com.
This page last updated: 11/09/2010