Wet and festering wounds - causes and therapy

Wet sores - causes and treatment

Anyone who has ever suffered a major injury knows the phase of the wound healing process, in which a not yet completely healed wound secretes a clear to yellowish wound secretion, after the initial blood flow is already long since dried up.

Colloquially, this secretion rinsing of an injury is also said to mean that the wound is wet. To some extent, this secretion flow is nothing bad, because behind it hides first of all a natural mechanism of the body. With the help of these secretions, the organism tries to protect against pathogens that could get into the wound. However, the flow of wound secretion is critically affected if it lasts for an above-average period of time and, in the worst case, is accompanied by pus secretions. Here wound healing disorders and / or wound infections are very likely. Details on weeping and festering wounds as well as suitable treatment measures reveal our contribution to the topic.

contents

• Wet sores - causes and treatment
• What is wound secretion?
• Emergence of weeping wounds
• Suppurating wounds due to wound infection
• Infection risk: wound healing disorder
• Wound infections and their consequences
• diagnosis
• therapy
• Aseptic wound treatment
• nutrition
• Medicine and homeopathy
• drugs
• surgery

What is wound secretion?

A wound fluid (exudate) in medicine is defined as a fluid that exits the wounded tissue quite specifically after the onset of an injury. The clear wound secretion is also referred to herein as serum, as it consists in addition to a small proportion of cell remains from the wound mainly from natural blood serum. This contains the following components:

• Water (about 91 percent),
• Proteins (about seven percent),
• Electrolytes, nutrients and hormones (about two percent).

Anyone who has ever suffered a major injury knows the phase of the wound healing process, in which a not yet completely healed wound secretes a transparent to yellowish wound secretions. This is also called serum, it consists mainly of natural blood serum. (Image: Mila Supynska / fotolia.com)

The word exudate comes from the Latin language and means translated as "leaking fluid". Medically, this mechanism of leakage of wound fluid is also referred to as the exudation phase in physiological wound healing. However, the important function of wound secretion within wound healing is not yet described.

In the case of superficial wounds, the exudate that exits first ensures that harmful wound germs are rinsed out, which causes a natural wound disinfection. In addition, the wound secretion in external injuries forms a protective wound crust - also called grind or scab - on the injured area of ​​the skin to "shield" the wound from external influences, while the blood serum below is involved in the regeneration of skin and tissue cells. For this purpose, the exudate clots and hardens, with the blood coagulation factors of the blood serum contained in the wound secret playing an important role. The coagulated wound secretion assumes a slightly yellowish to brown color as a result, which is why the grind usually appears slightly darker than the rest of the skin area. In addition, if necessary, admixtures of red blood cells from mitverletzten vessels that also darken the clotted exudate.

However, the ingredients of the serum not only cause conventional encrustation in the wound area, but also an increased cell division in the next step, which accelerates tissue regeneration. Unless there are complications in wound healing, minor injuries (e.g., minor scratching, lacerations, and abrasions) become crusty within one day so that wound healing can then proceed undisturbed.

Emergence of weeping wounds

The situation is different if the secretion continues to be given days after the injury. One speaks then of a weeping wound. There may be two reasons for this. The simplest explanation here is that a wound is simply very large and therefore requires more time to crust. The exudation phase can take several days, as is the case for example with severe burns or large abrasions.

In severe burns or large abrasions, the secretion can continue to be delivered even days after the injury. One speaks then of a weeping wound. (Image: Pornpimon / fotolia.com)

Unfortunately, the area of ​​wounds increases the risk of wound contamination. Even a slight foreign body irritation of the wound due to direct contact of the injury surface with dirt particles (for example in scouring or scratching wounds) is sufficient in this respect to initiate minor infection processes during the development of the wound. An alarming immune reaction occurs relatively quickly in wound contamination. It first causes the fine vessels and tissue cells in the area of ​​the wound to become more permeable to immune system defenses. This is intended to speed up the arrival of said antibodies at the site of injury and to facilitate their repair work in the area of ​​the injury.

Likewise, the increased vascular and tissue permeability leads to greater amounts of exudate in the wound, which then increasingly serves to flush out infectious agents. Chronically infected wounds in this context require a constant rinsing of pathogens, which is why the secretion flow does not dry up or clot. So it comes to a sustained wetting wound.

As already described at the beginning, weeping wounds do not pose a health problem. The secretion of the secretion is wanted by the body and should protect the wound in two ways:

• Wound cleansing - the pathogens that have already penetrated into the wound are returned to the outside with the wound flow, so that the wound is treated naturally.
• Infection control - as the pathogens can not overcome the fluid barrier of the wound secretion, as well as the defense mechanism of the antibodies contained therein, effectively preventing prolonged oozing of larger wounds from entering new pathogens from the environment.

So if a wound wets a little, it does not have to be the end of the world. Since wound injury can occur relatively quickly in the course of an injury, and the immune system usually reacts very violently in the wound, moulting can, to a certain extent, be regarded as a natural process. However, infection-related inflammations result in a significant change in the composition of the wound secretion. Because this is no longer just about the closure of a wound, but also to an active infection protection, it comes with wound inflammation and wound infections to an increased accumulation of exudate with the following substances:

• Infectious agents - Germs that have migrated into the wound are flushed out by the wound secretion, which is why the pathogens are increasingly in the exudate of infected wounds.
• White blood cells (leukocytes) - Leukocytes are responsible in infected wounds for the detection and control of infectious germs, which can be differentiated between the following, in the wound secret leukocytes:
• Phagocytes (macrophages) - according to their name, macrophages, known as phagocytes, eat harmful germs of infection, analyze them, and send the information obtained from the destroyed pathogens to the immune system, which then causes the production of specific antibodies.
• B lymphocytes - produce on alerting the immune system antibodies to fight the wound germs.
• T-lymphocytes - also detect and fight infectious agents around the wound.
• increased proportion of proteins - as the leukocytes consist of protein, like all defense cells of the immune system, proteins are also found in unclear exudate. In addition, proteins themselves also have a certain protective function, which is why they increasingly occur on injuries in the case of injuries.
• Cell residues - a certain amount of cell debris from the wound can not be avoided in the exudate. They also represent a form of wound irritation, which additionally promotes inflammation in the area of ​​the injury.

Important: Even if minor inflammatory processes and wound contamination can be classified as normal in case of an injury, it is essential to disinfect the wound promptly after its formation and then to keep it sterile so as not to develop a chronic or even festering wound!

It is important to disinfect a wound after its formation in a timely manner and then keep it sterile in order to prevent inflammation as much as possible! However, weeping can be regarded as a natural process to a certain extent. (Image: wittayayut / fotolia.com)

Suppurating wounds due to wound infection

Wet and festering wounds are not the same thing. Significant signs of pus admixture in the wound secretion is a noticeably altered color and consistency of the fresh exudate. If clear wound secretion appears yellowish only in the clotted state, then purulent wound secretion also shows a clear yellow discoloration even in the liquid state. In addition, purulent exudate is no longer transparent, but heavily thickened. This is due to an increased proportion of proteins, cell residues and of course infectious agents in the secretion.

If an injury has occurred from the outset in an infection-prone environment, ie in an unclean and heavily germ-contaminated environment, the risk of a purulent wound infection is, of course, all the greater. Typical examples of risky environments in this context are bathing establishments, construction sites, playgrounds or even the home garden. In addition, inpatient facilities such as hospitals or nursing homes, in which many germs circulate, are a special case.

Hospitals are actually institutions in which people should get well again. Unfortunately, the risk of infection in hospitals is very high. Again and again this is the talk of the so-called hospital germs. This refers to infectious agents that lead to infections especially after a stay in the hospital, preferably with the help of a wound infection. Typical pathogens in this regard include:

• staphylococci,
• enterococci,
• Klebsiella,
• Acinetobacter
• and Pseudomonas.

They are transmitted on the one hand by means of ventilation systems of the stationary facilities, on the other hand, of course, direct wound contact is conceivable. This is the case, for example, in surgical wounds, when the surgery and the postoperative care are not working properly.

Warning: A further complicating factor in hospital germs is a relatively dangerous development in the area of ​​germ resistance. Because of the constant use of antibiotics, multidrug-resistant bacteria have developed, which are preferably spread in inpatient facilities such as hospitals and nursing homes.

The risk of infection in hospitals is very high, if z. B. in the operating room and in the postoperative care is working dirty. A further complicating factor in hospital germs is a relatively dangerous development in the area of ​​germ resistance. (Image: Gorodenkoff / fotolia.com)

In addition to this specific scenario, there are of course a number of other conceivable influencing factors that favor a festering wound by germ-laden environments. Some of the most common causes are listed below:

• Injury to animal bites: Animal bites are usually not sterile. Food remains, but also bacterial contaminants in the mouth are common practice, which is why an animal bite is considered particularly infectious. Last but not least, with such a bite, infectious animal poisons can also enter the wound, causing pus formation. This is especially the case with snake or insect poisons.
• Injury from germ-contaminated objects: Whether contaminated surgical instruments or object involvement in accidental injuries and injuries due to physical altercations - the possibilities of contracting infection-laden and festering wounds through germ-laden surfaces are manifold. Outside the hospital, cuts and abrasions caused by contaminated glass fragments, sharp-edged metal fragments or dirty knives are usually involved in the event.
• inadequate sterility of the wound: In many cases, the occurrence of a festering wound also plays a role in the lack of hygiene measures for wound treatment. Sometimes germs that have entered the wound at the beginning remain in place because the injury has not been adequately cleaned, sometimes the wound is only insufficiently covered or a drenched bandage or a drenched plaster is not changed often enough. Speaking of wetness, apart from a weeping wound, moist wound closures are especially susceptible to infection. Especially when bandages and patches are inadequately ventilated, an oxygen-poor and moist environment results around the wound in which germs thrive excellently.

Infection risk: wound healing disorder

What is common among these factors is that, in addition to a wound infection, they also lead to delayed wound healing and thus to wound healing disorders. Because chronically inflammatory and in the process of infection conceived tissue can not or only with difficulty regenerate.

In addition to wound infection, there are other factors that affect rapid wound healing. This is especially true for pre-existing conditions or malnutrition. On the one hand, this can restrict the secretion flow itself, because the body does not have the necessary energy to produce enough exudate. On the other hand, the ability of the wound to defend itself can also be detrimental to the health problems, for example if the production of antibodies is delayed and therefore there are not enough leucocytes in the blood serum. The risk of infection by wound contamination increases enormously.

A brief overview of the most important influencing factors in the treatment of wound disorders can be found in the overview below:

• existing underlying disease: Many diseases of the body favor the occurrence of wound infections and wound healing disorders. This is partly due to the weakened by the underlying disease immune system. On the other hand, diseases such as chronic vascular disease can severely restrict the circulation in the wound area or lead to a general imbalance in the hormone system in the body. Examples of possible wound healing diseases are:
  • Diabetes mellitus,
  • Chronic venous insufficiency, peripheral arterial disease (PAD),
  • chronic infectious diseases (e.g., HIV or tuberculosis)
  • and Cushing's disease
• Nutritional error: The diet has a significant impact on wound healing, as many nutrients contained in the food are needed to close the wound. For example, a very low-protein diet deprives the body of proteins needed to produce antibodies. Also, the essential amino acids that the organism needs for the regeneration of cell tissue, can only be supplied through a high-protein diet. Other nutritional factors that negatively impact wound healing are obesity and vitamin deficiency.
• Certain medications: Some medications have a bad influence on wound healing as an unwanted side effect. These include drugs that inhibit blood clotting (anticoagulants). Also corticosteroids as well as some cytostatics and psychotropic drugs are said to have a wound-disturbing effect.
• Smoking: Nicotine is known to affect the blood circulation of organs and tissues. This also comes into play in wound healing, whereby not enough exudate often reaches the wound due to the circulatory disturbance.

Nicotine is known to affect the blood flow of organs and tissues. This also comes into play in wound healing, whereby not enough exudate often reaches the wound due to the circulatory disturbance. (Image: Ralf Geithe / fotolia.com)

Wound infections and their consequences

A wound that does not or only very slowly heals can both increase the risk of scarring and provoke the spread of wound infections in the body. In the worst case, in the course of such an infection happening threatens a blood poisoning (sepsis), which can end sometimes even fatal.

In addition, wounds that develop in an apparently polluted environment are at a particularly high risk of contracting tetanus. Behind this is an infectious disease caused by the bacterium Clostridium tetani which causes severe muscle spasms and heart damage. For this reason, preventive measures should always be taken to ensure adequate tetanus vaccination coverage.

Also not excluded is wound necrosis in infected wounds, ie the death of tissue in the area of ​​the injury. This occurs when tissue is no longer adequately perfused by sustained infection or inflammatory processes and tissue destruction ensues as a result of the lack of supply.

It can be seen that festering wounds are just the tip of the iceberg when it comes to the consequences of an infected wound. It is therefore all the more important to correctly interpret the signs of a serious wound infection in good time. Typical symptoms are:

• increasing pressure sensitivity and pain in the wound area,
• Swelling, redness and overheating of the wound environment,
• Persistent purulent and / or bloody wound flow (yellowish-greenish, milky secretion),
• unpleasant odor,
• mild to severe fever,
• general malaise,
• Nausea and vomiting
• and physical weakness.

diagnosis

The diagnosis of external wounds is often completed with a gaze diagnosis. It becomes more difficult when it comes to internal wounds. A weeping or festering wound can often lead to abscesses or edema, which can usually be detected only by imaging techniques such as ultrasound, CT or MRI. Endoscopic examinations are also conceivable in the case of weeping or purulent wounds in the interior of the body.

The diagnosis of external wounds is often completed with a gaze diagnosis. For internal wounds, most imaging procedures such as ultrasound, CT or MRI are appropriate. (Image: Tyler Olson / fotolia.com)

therapy

The two most important steps for the treatment of weeping and festering wounds are, firstly, the elimination of possibly existing pathogens in the wound environment by appropriate wound disinfection. Second, the risk of further bacterial colonization by extensive aseptic measures must be kept low until the wound has completely healed. Occasionally, surgery may be needed to speed healing.

Aseptic wound treatment

Aseptic wound treatment aims to keep germs out of the wound during regular wound care. Therefore, proceed as follows:

1. Before touching the wound and the top dressing, disinfect your hands or at least wash well with soap. If available you should possibly also wear disposable gloves.
2. After removing the cover bandage, the hands must be disinfected again, at least for very severely infected wounds. Next, the wound is sprayed with a mucous membrane-friendly disinfectant, so that really all skin areas are saturated. If necessary, carefully wipe off excess disinfectant with a sterile compress. It is also important not to touch the wound directly with your fingers during aseptic wound treatment, but to use sterile tweezers if possible.
3. The selected or prescribed by the doctor wound dressing must then be carefully and loosely applied to the wound, so that the tissue under it despite dressing or patch continues to get sufficient air. Overall, dressings made of compresses or bandages should be selected such that they generously surmount the wound dressing. For stabilization, if necessary, you can include the nearest joint in the dressing. (For smaller everyday wounds, this procedure should not be followed so closely, usually a brief disinfection or even rinsing of the wound with clean tap water and the provision of a small, sterile bandage or patch.) Also to the use of disposable gloves and sterile Instruments can be safely dispensed with.)
4. While the treatment of weeping wounds is limited to facilitating a healing process without complications and avoiding negative influences, the therapy of suppurating wounds additionally extends to the elimination of the infection. Here it is absolutely advisable to consult a wound therapist, because the repertoire of infection-eliminating dressings has grown very much in recent years. In addition, there are notable tips and tricks on almost every possible dressing, often known only to those who work with it daily. As a rule, dressing changes in infectious wounds are therefore carried out by medical specialists.

nutrition

The affected person can also do much to promote healing. For example, a protein-rich and vitamin-rich diet should be easy to achieve by eating quark dishes or meat meals and lots of fruits and vegetables every day. A nicotine withdrawal should also be considered in the sense of a positive wound healing in severe infections and wound healing disorders.

A protein and vitamin rich diet, such. B. Quark with fruits, also contributes to wound healing, as well as the abandonment of nicotine! (Image: annabell2012 / fotolia.com)

Medicine and homeopathy

In wound therapy, naturopathy has achieved a major rethink in recent decades. The trend is moving away from permanent disinfection and daily dressing changes and towards creating a natural environment, for example, by airtight dressings, which are changed only every 3 to 4 days and imitate a natural skin barrier. In addition, naturopathy offers a few wound dressings, which look a bit unusual at first glance, but have brought in studies undeniable successes. These include:

• Pads with silver solutions for wound disinfection,
• Pads with honey solutions for wound disinfection and wound healing promotion
• and live maggots for removal of infected and dead tissue (disgusting but effective).

Apart from that, there are of course a wealth of Wundheilkräutern that look very reliable. First and foremost here is the comfrey, which owes its name to the circumstance that it can achieve astonishing salvation progress especially in injuries and fractures in the leg area. Basically, comfrey is also a good help for all other types of injuries. Other medicinal herbs for the treatment of wounds are:

• arnica,
• mullein
• and yarrow

drugs

In addition to the local treatment of the wound itself, it is also possible to use systemically acting medicaments which, on the one hand, are beneficial for wound healing and, on the other hand, can also treat negative underlying diseases. For example, a therapy with antibiotics and corticosteroids is possible, if an extension of the infection is to be expected.

The adjustment of the derailed blood sugar level in diabetes patients, for example by means of oral antidiabetics or insulin injections, plays a major role in wound healing.
It is also important to remember the accompanying symptoms. Fever and pain not only affect the body, but also wound healing. For this reason, pain medications can also be included in the treatment regimen. Often it is advisable to administer them shortly before the dressing change to make it bearable for the person concerned.

surgery

If the wound healing disorder is very advanced and affects not only the upper skin layer, but spreads to the depth of the tissue and forms wound bags, often remains only the surgical excision of wound tissue by means of debridement. In most cases, this can be done under local anesthesia, but it can also happen that the wound bags are so deep and even on the bone overlap, so the operation must be performed under general anesthesia. The surgeon cuts out the infected tissue over a large area and removes any areas that can no longer be rescued. Sometimes he tries to achieve an adaptation of the wound edges by creating sutures.

A relatively new form of therapy for very deep and poorly healing wounds is the so-called Vac therapy. Here, the wound is hermetically sealed and created by a suction, a negative pressure environment, which studies have the consequence very beneficial to the wound healing. (Ma)