Dermatologist’s advice: Keep away from powder for skin wounds

The skin is the largest organ of the human body, The total area can reach 1.2-2 square meters, Tilting is the size of a single bed. The thickness is usually 0.5-4.0 mm, excluding the skin of the subcutaneous fat layer, which depends on the degree of fat and thinness. The total weight of these skins accounts for about 16% of the human body weight. On the surface is the epidermis, and below is the dermis, which forms our body’s first line of defense.

Since our skin is probably the most vulnerable part in the outermost layer, and once the skin is damaged, there will be four problems: infection, hemorrhage, pain and scar. Correctly handling these four problems is the best way to recover as soon as possible and leave fewer scars after skin injury.

Early debridement to avoid infection

Now of course we already know that infection is caused by bacteria and other microorganisms. However, before the world’s first microscope appeared in 1590, no one had seen the existence of this microscopic world and could not find, let alone effectively prevent and control it. Therefore, infection has always been one of the main causes of human death in ancient times.

The human epidermis has a strong resistance. The complete epidermis can block a large number of bacteria out of the body. Occasionally, fish slip through the net. Immune cells responsible for patrolling blood vessels can also find and destroy it. However, if the epidermis is damaged or the immune function decreases, these microorganisms will take advantage of it. Experimental results confirm that at least 1 million staphylococci need to be injected subcutaneously to make normal skin fester. But for damaged epidermis, only 100 are enough.

Before antibiotics were discovered, Fire and oil burning are the most common methods that people can use to prevent infection. Injured skin is usually baked with fire and even boiled oil is poured on the wound. These horrible therapies were used to treat serious skin injuries and were followed in 2000 until French military doctor Ambres Parre accidentally terminated the treatment in the 16th century.

In 1536, the young military doctor, unable to bear to watch the soldiers suffer, mixed egg yolk, rose oil and turpentine to smear wounds on some injured soldiers. To his surprise, those who used this mixture only felt slight pain and the wounds were not inflamed. On the contrary, those wounded who burned the wounds with hot oil not only suffered severe pain, but also the wounds were red and swollen. In this way, a young man accidentally ended this painful and ineffective treatment method.

Now one of the ways for surgeons to avoid skin infection is to clean up the wound as soon as possible. Can skin wounds be treated with powder?

The method of using powder for skin wounds can no longer be studied. It is recorded that as far back as the Spring and Autumn Period in our country, Castration was already very common at that time. Alum powder and resin were mixed to coat wounds to stop bleeding from castration wounds. This method was circulated until the Qing Dynasty. The use of powder and other things to smear or fill wounds is roughly the embodiment of this so-called [traditional therapy] or [folk wisdom].

As a clinician, I have seen all kinds of wound fillers: White powder, talcum powder, avant-garde mycin capsule powder, amoxicillin tablets crushed powder, sulfanilamide crystal powder, bark, rice crust, tobacco shreds, soot, cold rice, grass crumbs, sawdust… on the side can plug the wound things are generally used. However, patients with infection, ulcer, abscess and dermatitis caused by these reasons are not in the minority.

What effect will external powder have on skin wounds? For human body, solid particles such as powder and powder are foreign bodies that cannot be absorbed, which will aggravate inflammatory reactions and induce granulomatous lesions (a local allergic reaction and granulomatous lesions caused by foreign bodies).

External application of powder to wounds will bring unpredictable pollution to wounds and increase debridement difficulty to doctors. For foreign body reaction and foreign body granuloma, the wound will also develop into irregular and hard nodules or plaques, which may also lead to ulceration of the wound surface or formation of abscesses, thus prolonging the course of the disease.

Some people feel that the blood flowing out of the wound slowly stops after the powder is removed, The powder will at least have hemostatic effect. However, there is no evidence that the powder is superior to simple compression hemostasis. Sprinkling powder to stop bleeding slowly is actually because the body’s own coagulation mechanism is beginning to work. In other words, No powder is used to stop bleeding. (At present, there is no evidence to prove that the past soil methods, such as stopping bleeding with red brick powder and soot, can promote platelet aggregation and coagulation factor aggregation, so it is unlikely to play a role in stopping bleeding.)

How can skin injury not leave scars?

Whether scars appear depends on the depth of the wound.

The depth of the wound surface must at least reach the dermis layer under the epidermis to cause scars. Our epidermis is very thin, the average thickness of adults is only about 0.1 mm, and the average thickness of cheek epidermis is only 0.05-0.08 mm. Children’s epidermis is usually thinner than adults. The epidermis thickness of the back of the head, palms and soles is almost twice that of cheeks.

Therefore, the face of very shallow wounds can lead to scar, and the hands and feet those skin thick area is relatively not easy to scar. Of course, the size of the scar also depends on the individual constitution, wound shape, wound treatment methods, age, local capillary abundance of these factors.

Generally speaking, the younger the age, the more abundant the local capillaries are, the easier it is to leave scars. Compared with the covered wounds, the exposed wounds are also easier to leave scars. Not to mention people with scar constitution, the surface scars may continue to increase after the wounds heal.

It is not easy to leave scars when dealing with wounds that are not joint parts or parts with loose skin, such as our belly.

Improper wound treatment, such as the use of iodine tincture, mercurochrome, amethyst and powder (foreign body) directly applied on the wound surface, is a common cause of complications after various injuries caused by human factors. Mercurochrome and amethyst are now rarely sold in pharmacies, iodine tincture is gradually replaced by iodophor, but the use of powder to apply wounds is still not uncommon.

For people with diabetes, improper wound treatment can lead to extensive necrosis of local tissues, which may require amputation to save their lives. If amputation is not required by luck, months of debridement and dressing change over the years are enough to make the patient miserable.

To sum up, it is: Young children, cheek, after mercurochrome/mercurochrome/iodine and other irritant disinfectant + powder coating, wide and depth of more than 0.1 mm wound, the obvious degree of scar hyperplasia is much more than that of an adult. However, narrow and deep dermis knife cuts, after correct debridement treatment of palms and soles, are not easy to leave scars.

Non-medical staff should how deal with skin trauma?

Referring to the suggestions of Mayo Clinic and WebMD, the largest medical and health service website in the United States, the general scratches and cuts that families can deal with are as follows:

Hemostasis. Press the wound with clean cloth or bandage for 20-30 minutes to stop bleeding; If the bleeding still cannot be stopped, the pressing time can be prolonged and the wound can be raised. Don’t open it during the hemostasis process, which will make the coagulation slower instead.

Cleaning. Normal saline or clear water is the first choice for superficial wounds. It is not necessary to use hydrogen peroxide, iodophor and alcohol to clean the wound. The effect may not be better and may also lead to delayed wound healing. It is really inconvenient to find 0.5-1% iodophor for clear water.

Apply antibacterial ointment. After cleaning the wound, apply antibacterial ointment and cover it with aseptic gauze, and fix it with adhesive tape or bandage. The antibacterial ointment we are talking about here is a kind of external ointment containing antibiotic components.

Change dressings. Change dressings at least once a day, and also when dressings are wet or contaminated. If you are allergic to bandage adhesive, use elastic (adhesive) bandages instead.

Please seek medical treatment in time in case of any of the following circumstances:

The bleeding course is sprayed, and the hemostasis effect of continuous pressing is not good.

Foreign body residue found during wound flushing is difficult to remove.

Wounds requiring suture: wounds more than 6mm deep, open wounds, serrated wounds, wounds with fat or muscle exposed;

The wound does not heal or any redness, swelling, heat pain or exudation is observed;

The need for tetanus vaccination.

For those deep and small nail stab wounds, serious pollution/infection, animal bites and chemical burns, they should seek medical treatment in time and follow the doctor’s advice.

Author: Liu Xin