What is needed for wound healing?

This is the 3661th article of Da Yi Xiao Hu

If you ask me, what is needed for wound healing? I will tell you that wound healing requires "the right time, the right place, and the right people", and you must think I am joking. In the outpatient clinic, family members often ask me, if increasing the frequency of dressing changes will make the wound heal faster? Can eating pig's trotters make the wound heal faster? I usually tell family members that the wound grows on its own, and what we can do is to create the best environment for the wound to heal. Next, let's take a look at how to create the best environment for wound healing.

Whether it is an acute wound or a chronic wound, cleaning is the most fundamental. If there is blood accumulation, pus, foreign matter, or rotten flesh in the wound... it must be cleaned up, otherwise, these will become the favorite breeding ground for bacteria. You must think that everyone knows what I said, and you can't wait to scrub the wound with disinfectant several times when changing the wound. But what if these blood accumulation and pus accumulation turn into dry scabs? Can you identify them and clean them up? If the outer opening of the wound is very small, can you ensure that the accumulated fluid deep in the wound is drained clean? There are many wounds that have not been well changed. After thorough cleaning, it is found that the sutures have not been absorbed and have become foreign matter that affects healing.

Just like building a house, after cleaning the foundation, bricks and cement can be transported to start building the house. In the same way, it is impossible to have a wound without "bricks and cement". Is there any truth in the saying "you are what you eat"? This sentence is somewhat reasonable, but not entirely reasonable. Let's take a look at what nutrients the wound needs. The necessary nutrients in the wound healing process are protein, vitamin A, vitamin C, vitamin B6, vitamin B12, folic acid, zinc, iron, etc. and sufficient calories. Vitamin A plays a positive role in the inflammatory phase of wound healing. It increases the inflammatory response by acting on the lysosomal membrane, increases the number of monocytes, macrophages and lymphocytes entering the wound, and regulates collagenase activity, which helps collagen synthesis and maturation, epithelial regeneration and angiogenesis. Vitamin C is needed for neutrophils to produce peroxides to kill bacteria, and is also beneficial to the phagocytosis and migration of macrophages. At the same time, as a cofactor for the hydroxylation of proline and lysine, it can promote collagen synthesis and cross-linking and improve the strength of the wound. Trace elements are closely related to protein synthesis. I believe that eating pig's trotters alone should not contain so many nutrients. And most importantly, you need to supplement enough calories, otherwise these supplementary nutrients will be used to maintain basal metabolism, and what will be used to heal the wound?

A clean wound with enough nutrition should heal quickly, right? No, have the causes of the wound been removed? Are the factors of pressure, shear force, friction, and moisture that cause pressure sores still there? Is the blood sugar level of diabetic foot ulcers under control? Are the blood vessels of arterial ulcers reopened? Have lower extremity venous ulcers been treated with pressure? (I feel like these are all soul-searching questions)

If the factors that affect wound healing are removed, then please wait for the wound to heal on its own happily. You must be happy, because if the patient has high mental stress, depression, insomnia, etc., the patient's own immunity is reduced or the patient has no intention to take care of the wound, it will also hinder the healing of the wound.

Author: Shanghai Eighth People's Hospital Physical Examination Center

Liu Lifang

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