Wound Home Care

This wound home management program provides information for patients on wound home care. Read the Wound Home Skills Kit: Lacerations & Abrasions for full information.

Quick Care Steps

Clean your incision as directed by your doctor. Typical care instructions include:

If your hands are visibly dirty, wash your hands with soap and water for 15 to 30 seconds; if your hands are not visibly dirty, use a 60% alcohol-based hand gel.
Wash the wound area with soap and water. Let the water run on the wound until all the soap residue disappears. Use a cotton swab to remove any blood or crust that forms.
If the wound does bleed while you are cleaning it, cover the wound with a gauze pad or towel and apply firm pressure for 5 full minutes. If the bleeding does not stop, call your health care provider or go to the hospital.
Your provider may tell you to use an antibiotic or white petroleum for the first week to keep the wound moist to prevent infection, promote healing, and decrease scabbing.
Do not use disinfectants and antiseptics—like hydrogen peroxide, rubbing alcohol, or iodine—to clean open wounds. They are more likely to damage tissue than to help it heal.
Do not soak the area or swim until you are told to by your doctor.

View tips for surgical wound care.

When to Get Help

Call your doctor if:

Your wound is deep
Your wound has ragged edges
The edges of the wound stay wide open
Your wound is leaking a thick, creamy, grayish fluid
Your wound bleeds in spurts and blood soaks through the bandage
Bleeding does not stop after 10 minutes of firm, direct pressure
Red streaks are on your skin near the wound
You have a puncture wound or a deep cut
The area around the wound feels numb
You have a temperature at or over 101°F (38.3°C)
You can’t move without pain
You have not had a tetanus shot in more than 10 years
You have a skin injury and are a diabetic or have a vascular disease
You are taking medications such as steroids or anticoagulants (blood thinners), which may affect wound healing

Types of Wounds

It is important to find out what kind of wound you have, as each wound is treated differently and heals differently. If you have diabetes, you may already have decreased circulation and feeling in your arms or legs, and it may take longer for your wounds to heal. If you have diabetes or a bleeding problem, contact your health care provider when skin injuries occur.

Lacerations

A laceration is a cut that goes all the way through the skin. The cut may be small and cared for at home. Deep lacerations go beneath the skin through the fat layer or to the muscle layer and may need medical help right away.

Lacerations on fingers, toes, or hands are common, and many will heal on their own. A fingernail or toenail laceration may cause a tear with a large bruise, and some blood may pool underneath the nail. If the blood is under more than half of the nail, your doctor may remove the nail in case there are other injuries below it.

Treatment: Seek medical care if you have a partial amputation or a crush injury because there may also be a fracture. The nail bed will be checked for a fracture or break. Lacerations on your hands or feet may involve deeper structures under the skin, like tendons and nerves. If you have any loss of feeling or movement around a deep laceration, it may mean there is a cut through a tendon or nerve.

Puncture/Stab Wounds

Puncture wounds are commonly from stepping on a nail or other sharp object. They are not usually stitched (sewn) closed with sutures. These may bleed for the first 24 hours.

A stab wound from a sharp object usually causes a small opening at the skin but may also go very deep. Nerves, tendons, and organs can be injured, so medical care is required.

Treatment: The wound is left open to allow drainage in case of infection. These should be cleaned well with soap and water and covered with a gauze dressing. Antibiotics may be given if the wound is deep or there was dirt or debris in the wound.

Bites (Human & Animal)

Human bites usually cause a small puncture wound that breaks the skin. They are easily infected due to the large number of bacteria in human saliva. Fingers or earlobes are common areas for these bites and have limited blood supply and ability to fight infection.

Treatment: Any bite that breaks the skin needs to be cleaned immediately with soap and water. Call your health care provider if the bite goes through a joint. This can lead to a serious infection and may need surgery.

Dog bites may cause more of a jagged laceration. They should be thoroughly cleaned with soap and water because they can easily become infected.

Cat bites have a very high rate of deep infection that may need surgery if left untreated. If treatment is delayed, a cat bite infection can cause serious and permanent damage to tissues, such as joints and tendons.

Treatment: They should be washed thoroughly with soap and water and covered with antibiotic ointment. Deep puncture wounds may need an absorbent dressing.

Bite treatment: Contact your health care provider if the skin is broken. You should let them know when you last had a tetanus vaccination or if you never had a tetanus shot. If the animal that bit you is healthy and can be observed for 10 days without signs of rabies, you will likely not need treatment for rabies.

Skin Tears

A skin tear is when the outer layer of the skin is pulled back. Skin tears are common in older adults with fragile skin and anyone taking steroid medication. People who have difficulty walking, use a cane or wheelchair, or have vision or hearing loss may be at greater risk for skin tears.

Treatment: Cover and protect the skin tear with a moist dressing like petrolatum-impregnated gauze, such as Systagenix Adaptic® or Xeroform®. They are inexpensive and widely available. Extend the dressing at least one inch wider than the wound to completely cover it. Apply a secondary dressing or bandage like dry gauze to keep the moist dressing from sliding off and to protect the wound. Tape the end of the bandage to the bandage itself to prevent taping the skin. Carefully remove dressings to prevent any further skin damage or moisten a dry dressing to make it easier to remove.

Abrasions

An abrasion occurs when skin is rubbed away, usually if the skin comes in contact with a rough surface. Examples are a skinned knee or a road rash. Abrasions can be painful, and bleeding will start right after the skin is broken.

Treatment: Clean minor abrasions with soap and water. Minor or superficial abrasions should heal in a short period of time.

Treatment for deep abrasions: Your health care provider should inspect the wound for:

Dirt, debris, or an object in the wound
Any other injuries like fractures
Injuries to deeper structures like tendons, nerves, and blood vessels

Your wound may need to be closed with sutures or a skin adhesive. Let your health care provider know if you have any allergies or have had a reaction to general or local anesthetics.

Your Skin

Your Skin’s Structure

Your skin has the job of protecting your body, so it is made to be tough and stretchy. The 3 main layers of the skin are the epidermis, dermis, and subcutaneous fat.

Epidermis

The epidermis is the top layer of skin, which is the part of the skin you see. New skin cells are made at the bottom of the epidermis. They push their way up and flake off about a month after they form. Your skin is always making new cells—that’s why your skin can heal. Just remember that your new skin cells may be a little tender and fragile in the beginning. The epidermis makes melanin, which is the pigment that gives skin its color. Melanin is increased when exposed to the sun. You will need to protect your wound from the sun—otherwise, the new pigment may be darker and that part of the skin will look different. The epidermis also has immune cells that are there to protect your body. So that is why when your skin layer is broken, you are at a greater risk for infection.

Dermis

The dermis is the second layer of skin. It’s much thicker and has several jobs:

Makes sweat—which comes out of little holes in your skin called pores.
Contains nerve endings—they help you feel things. If the dermis is damaged, sometimes the skin has less sensation or feeling for a while.
Grows hair—if your hair roots are damaged, you may have scar tissue that no longer grows any hair.
Makes oil—this helps keep your skin soft and smooth.
Brings blood to your skin—this is why when you cut into the dermis layer, you will have more bleeding.

Subcutaneous Fat

Subcutaneous fat is the bottom layer of skin. This layer:

Attaches the dermis to your muscles and bones.
Contains the larger blood vessels and nerve tissue that supply blood and feeling to the rest of your body.
Contains fat that helps control your body temperature.
Stores the fat in pads that help protect your muscles and bones. As you age, the fat layer thins out and becomes more delicate. Your skin may be more sensitive to bruising or skin tears.

How Your Wound Heals

There are 3 ways that wounds can heal:

Primary healing: The wound is clean and all layers of your skin are closed. Your wound will heal in a minimum amount of time, with no separation of the wound edges and with little scar formation.
Secondary healing: The wound’s deep layers are closed, but the superficial (top) layers are left open to heal from the inside out. This healing will be seen in cases of infection, trauma, tissue loss, or incomplete closure of your skin tissue.
Tertiary healing (delayed primary closure): The wound is first cleaned and observed for a few days to make sure there is no infection before it is surgically closed. These wounds include injuries such as dog bites or lacerations such as jagged stab wounds.

The amount of time it will take your wound to heal depends on the type of wound and your general health. Most wounds heal within 2 weeks in healthy children and adults. Healing may take longer if you have a condition like diabetes; you are a smoker; you are taking drugs, such as steroids or chemotherapy; or if you have a weakened immune system.

Open Wounds

Open wounds, like a paper cut, do not need sutures, staples, or other types of closures to help them heal. Wounds that are left open to heal, like skin tears, may require special care with bandages or dressings that keep the wound bed moist and do not stick to the wound. Ask your health care provider how to clean, bandage, or apply a dressing to an open wound if needed.

Deeper lacerations and abrasions may need to be closed by a health care provider using sutures (stitches), staples, Steri-Strips®, or tissue adhesive.

DISCLAIMER

This information is published to educate you about preparing for your surgical procedures. It is not intended to take the place of a discussion with a qualified surgeon who is familiar with your situation. It is important to remember that each individual is different, and the reasons and outcomes of any operation depend upon the patient’s individual condition.

The American College of Surgeons is a scientific and educational organization that is dedicated to the ethical and competent practice of surgery; it was founded to raise the standards of surgical practice and to improve the quality of care for the surgical patient. The ACS has endeavored to present information for prospective surgical patients based on current scientific information; there is no warranty on the timeliness, accuracy, or usefulness of this content.