Superficial wounds, from minor scrapes and cuts to light burns, are common in everyday life. These injuries involve only the uppermost layers of skin. While they may seem insignificant compared to severe injuries, they still require proper care and monitoring to ensure optimal healing. In this article, we’ll cover the characteristics of superficial wounds, their treatment approach, the healing stages, and the latest advancements in wound care.
From Scrapes to Scratches: Characteristics of Superficial Wounds
Just what are superficial wounds?
They’re entries that involve only the epidermis and superficial dermis. These wounds do not penetrate the subcutaneous tissue or underlying structures. As their name suggests, they are usually less severe and heal more quickly, which means these will most likely be handled by patients at home or by non-wound care specific practitioners. But it’s always a good idea to refresh on the basics, especially when that means educating patients who may need to handle these on their own.
Characteristics of Superficial Wounds
- Shallow depth: These wounds involve only the epidermis and upper dermis, not the subcutaneous layers
- Minimal bleeding
- Irregular edges: Unlike deeper lacerations, superficial wounds have diffuse edges
Common Types of Superficial Wounds
- Abrasions: These are usually caused by rubbing or scraping against rough surfaces, which removes the top layer of skin. Typically, there is very little bleeding involved, but they still require cleaning to avoid infection
- Lacerations: Cuts, slices, or tears in the skin, often caused by sharp objects or glass, and may bleed quickly if deep.
- First-degree burns: While painful, these burns only involve the epidermis. They are red, without blisters.
- Friction burn: Similar to abrasions in their mechanism, friction burns often have the pain and appearance of a first-degree burn.
- Superficial puncture wounds: These may occur with any pointed object, such as a nail. There may be no bleeding externally, but puncture wounds can bleed internally.
Assessment and Approach
As with any type of wound, a systematic approach is preferred to provide proper assessment and treatment.
- Thorough Cleaning: The initial process involves washing hands and wearing gloves to prevent infection. Then, clean the wound with soap in water or sterile saline and remove any foreign material. For abrasions, general scrubbing may be necessary to remove the foreign debris. An antiseptic solution like povidone-iodine or chlorhexidine can disinfect the wound.
- Evaluating Tissue Damage: After cleaning, examine the depth of the wound, confirm that it is superficial, and check for any signs of deeper tissue involvement. At this point, assess shape and size.
- Checking for Signs of Infection: While superficial, these wounds can still become infected. Signs to look for include redness, inflammation, abnormal scent, or pus.
- Assessing Tetanus Immunization Status: The patient’s tetanus immunization status should always be verified for any wound. Administer a tetanus booster if necessary, especially if the wound is dirty or contaminated. If the wound was the result of an animal bite, rabies vaccines should also be addressed.
- Considering Wound Location and Scarring Potential: The location of a wound can make treatment more challenging. For example, wounds on joints or areas with high movement may require special care. A wound on the face may need further attention to minimize the effects of scarring.
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Current Treatment Options
After the initial assessment and cleaning of the wounds, the following techniques should be used.
Applying Antibiotic Ointment
Antibiotic ointment may reduce the risk of infection and promote healing. Over-the-counter ointments are typically sufficient for this purpose. However, honey-based ointments have shown promising results in recent studies.
Choosing Appropriate Dressings
Selecting the appropriate dressing can make a difference in anyone’s healing process. The following principles apply: for dry wounds, use a moisture-retentive dressing to promote healing; for moist wounds, use an absorbent dressing to help manage the exudate. Advanced dressings, such as hydrocolloids or foam dressings, may be used when maintaining moisture balance, which is essential.
Pain Management
Over-the-counter medications such as acetaminophen or ibuprofen may be used to manage pain routinely. Cool compresses can provide relief for burns. Topical analgesics may be considered for localized pain relief.
Infection Monitoring
Educate patients on signs of infection, such as increasing pain, redness, or swelling, and schedule follow-up appointments if infection occurs or worsens.
Stages of Wound Healing
Hemostasis
Hemostasis is the first wound-healing stage, lasting two days or more. At the first sign of a wound on the body, the blood vessels constrict to reduce blood flow. In addition, clotting factors are released, forming a clot in conjunction with fibrin. This action prevents further blood loss, and likely occurs quite quickly for superficial wounds.
Inflammation
The inflammatory phase can last seven days in acute wounds and much longer in chronic ones. During this phase, blood cells enter the wound area and destroy bacteria and debris to prevent infection. This process helps prepare the wound bed for new tissue growth. Physical signs of this phase include redness at the wound site, swelling, heat, and pain. In the case of superficial wounds, these are unlikely to be bothersome or painful, but the patient should be careful not to reopen the wound in this stage.
Proliferation
In the third phase, proliferation, the wound is filled with granulation tissue. This process also involves blood vessel formation and wound contraction. Due to the presence of inflammatory agents, the new tissue may appear red or pink. Tissue regeneration depends on the presence of collagen, which is the limiting factor in this process. This phase can last for four days or up to three weeks.
Remodeling
The fourth phase, remodeling or maturation, may occur over months or years, depending on the severity of the initial wound and its location and treatment methods. During this phase, the new tissue generally becomes stronger over time. The strength and elasticity of the skin relies on collagen production. Scar tissue results from collagen build-up and is considered 20% weaker and less elastic than the original skin. Even superficial wounds can form scar tissue, especially discoloration.
Time Frame
In general, superficial wounds heal quickly, usually within five to 10 days. However, factors such as the patient’s age, overall health, and wound care can affect healing time.
Factors That Affect Healing
- Age: Wound healing slows as we age. Skin becomes thinner, and the body shows a decreased inflammatory response. As a result, the skin is predisposed to injury and takes longer to heal. This may mean even superficial wounds take longer to heal.
- Nutrition: Malnutrition, particularly with poor protein intake, decreases the formation of collagen, blood vessel formation, and fibroblast production.
- Obesity: Anyone who surpasses their ideal body weight by 20% increases their risk of infection during wound healing.
- Medications
- Nonsteroidal anti-inflammatory drugs (NSAIDs): Pain relief is produced by inhibiting PGE2, which mediates inflammation. Also, NSAIDs are known to reduce the formation of blood vessels.
- Steroids: These have anti-inflammatory and immunosuppressive effects, reducing wound healing.
- Smoking: Nicotine causes vasoconstriction, decreasing the needed blood flow for healing. Nicotine also reduces the immune response, increasing the risk of infection.
- Diabetes: Two common complications of diabetes, peripheral neuropathy and peripheral artery disease, affect the proliferative phase of healing and thus slow overall wound recovery.
- Malignancy: Chemotherapeutic agents delay the inflammatory process and decrease collagen production. Radiation therapy can damage epithelial cells, cause skin breakdown, and slow the healing of new wounds.
Special Considerations: The Young and Elderly
Specific patient populations may require additional resources or level of attention.
Pediatric
While the structure of a whole-term baby’s skin appears to be similar to that of adults, the dermis is only half as thick as that of adults. This thickness increases with age, but as a result, pediatric skin is much more vulnerable than that of adults.
As with adults, a thorough physical assessment is essential for developing an effective treatment plan, including the above recommendations for assessing dimensions and characteristics of the tissue levels of exudate and signs of infection.
One particularly challenging aspect of treating the pediatric population is gauging the pain or anxiety of the patient. Pain intensity can be increased due to fear, stress, or emotional distress. Complicating this matter further are the limitations in communication with infants and very young patients, who have a much smaller or no vocabulary at all.
Even something as straightforward as a dressing can present a problem for treating pediatric patients, as many do not come in sizes small enough. Infants and children are more prone to skin stripping caused by dressings, so the use of silicone dressings, when possible, should be considered for the very young. To reduce the risk of further skin irritation, secure the dressing with a loose bandage or tubular bandage when possible.
In addition, the parents are family members caring for the child, who becomes an immediate member of the wound care team and requires sufficient education before discharge.
Geriatric
The aging process amounts to an inevitable decline of the body’s organs, including the skin. By age 20, subtle skin changes begin regardless of external exposure. Between 30 and 80, the epidermis thins, and the turnover rate of the structural cells reduces by 30 to 50%. This decreases the transfer of nutrients between the two layers, affecting immunologic and mechanical function.
As the epidermal interface with the dermis flattens, the skin integrity decreases and becomes more vulnerable to simple trauma and shearing forces. As with infants above, the dermal thickness is about 20% less than that of younger adults. As a result, the dermis becomes increasingly avascular. Collagen degradation further compromises the skin’s ability to heal.
While the initial approach to treatment of a superficial wound in the elderly is the same for younger patients, there should be an increased level of suspicion for the development of infection or chronic wounds.
Superficial Wounds: Treat at Home or Seek Medical Care?
Most superficial wounds can be treated at home with simple cleaning and appropriate dressing, but there are times when medical care should be sought for optimal treatment.
Patient should seek medical care when:
- Bleeding cannot be stopped with normal pressure or elevation.
- Bitten by an animal or another human, due to the high infection rate.
- Sutures may be necessary to achieve the best cosmetic appearance, especially with wounds around the lip or eye.
- Evidence of infection appears, like redness, pus, or inflammation.
- Patient’s tetanus immunization is not up to date, in which case a booster should be given within 48 hours.
Recent Advances in Superficial Wound Care
With many new therapies, wound treatment continues to evolve, from dressings to stem cells.
Dressings
- Liquid skin bandages: These create a waterproof seal over the wound, promoting faster healing and providing a barrier against contaminants.
- Nanofiber dressings: These advanced dressings provide an optimal environment for healing while allowing for gas exchange.
- Silver-based dressings: These dressings have broad-spectrum antibiotic coverage.
- Honey-infused dressings: Several studies have shown that honey-based dressings promote healing and prevent infection.
Stem Cell Therapies
- Mesenchymal stem cells: Topical application of these cells has accelerated the healing of wounds.
- Exosomes: Stem cell-derived exosomes are being studied for their regenerative properties, aiding in healing.
Smart Dressings
- Dressings with embedded sensors: These smart dressings can detect changes in pH, temperature, or bacterial load, reducing complications in wound healing.
- Color-changing dressings: This dressing is currently in development, but the hope is that colors indicate the need for changing or the presence of infection.
Not So Superficial Wounds
Even though they are sometimes seen as small, superficial wounds need to be properly cared for to promote healing and avoid complications. Healthcare professionals can effectively treat and counsel patients by knowing the distinctive features of these wounds. New therapies and technology promise to significantly enhance the care of superficial wounds as research progresses, resulting in improved outcomes and quicker healing times.
It is essential for healthcare providers, as well as patients with superficial wounds to be up to date on the most recent treatments in wound care. The optimum care for superficial wounds can be achieved through established wound care techniques with cutting-edge, novel methods that encourage quick healing and reduce the chance of complications as a second line of defense with any complications.
