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What’s in your first aid kit to help manage a wound, and when should you seek medical attention? Pharmacist and Credentialled Diabetes Educator Donna Itzstein, and Registered Nurse and Credentialled Diabetes Educator Amanda Callaghan, take us through some of the products available and how to use them. 

Skin wounds aren’t really a laughing matter. We all get them, particularly in summer when we tend to wear open-toed shoes and less clothing. Over the years, approaches to wound care have changed — not just the products on the shelf but the way wounds are treated. 

Recognising signs of infection 

Having diabetes can increase your risk of infections, and wounds, cuts and grazes take longer to heal if they become infected.  

It is important you can recognise the signs and symptoms of an infection so you know when to seek prompt medical attention. Technically all wounds and burns should be looked at by your medical team; however, before you can see your health team you can do some basic first aid. 

Head straight to the doctor if you have the following: 

• Bleeding that cannot be controlled, or a wound you think needs stitches  
• You can’t remember when you last had a tetanus injection 
• A wound that fails to heal, ulceration occurs, or if you have had ulcers previously 
• You have callouses on your feet or severely cracked heels, see a podiatrist 
• Wounds that break open or are more than skin deep 
• A wound that is weeping, develops an odour, or appears infected 
• Other symptoms such as bleeding from your mouth, nose, eyes, ears, or genital area 
• A bad headache, loss of consciousness, slurred speech, or blurred vision 
• Redness around the wound that increases in size or becomes more painful and swollen, or you develop a fever 
• Animal bites 
• Burns that are larger than a 20-cent coin or deeper than your first layer of skin, or are on your face or genital area. 

 Your medical team may stitch, staple or glue a wound if: 

• You cannot control the bleeding 
• A foreign object is in the wound 
• The wound is on your face, hands, mouth, or genitals. You may need stitching for cosmetic reasons and proper healing 
• The wound is greater than 6mm deep and you can see yellow fatty tissue or bone 
• If the edges of the wound need to be pulled together to cover a gap of exposed tissue 
• If the open wound is on an area of the body with a lot of movement. 

Wound cleansing 

Your medical team may recommend you use an antiseptic on your wound. An antiseptic on broken skin may reduce the risk of infection. Gently cleansing with saline or tap water (chlorinated or boiled and cooled tank water) can be used to remove dirt, sand, or gravel from a wound such as a graze, skin tear or shallow cut. You don’t usually need an antiseptic as antiseptic can slow healing or restart bleeding. Reserve antiseptic for situations where your skin is broken in the presence of highly infective agents such as another’s bodily fluids, faeces, or rotting matter. Always follow the instructions when using an antiseptic. If the solution is strong, dilute it to avoid burning. If you use a disinfectant wash, leave it on for three to four minutes, and rinse it off with tap water or saline.  

You should only clean the wound yourself once. If you think a wound requires re-cleaning, go to your GP or nurse practitioner. If you need to dry a wound after cleaning, use a product that will not stick or leave lint. Cotton wool can be used for gentle, wet cleaning of the area, but is not suitable for drying. 

Burns and blisters 

Creams, ointments and gels are generally not necessary for healing. The exceptions are burns and skin tears which your medical team may recommend a hydrogel for. Always run a burn under cool water for 20 minutes before doing anything else. For a small burn apply a liberal amount of gel and then apply a dressing. Do not burst a blister as it protects the underlying skin and reduces infection. 

If your wound is clean and not infected, leave it alone. If you want to add an ointment before applying a dressing you could use a povidone iodine such as Betadine, medical grade manuka honey, or a silver dressing to reduce the risk of infection. There is no need to reapply the ointment when you change the dressing. All infected wounds, burns or blisters larger than a 20 cent piece, burns that don’t feel painful, or deep burns regardless of size, will require immediate medical attention. 

Dressings for a wound 

Plastic and fabric strips are a product used for shallow cuts. They can be waterproof and non-waterproof and come in a range of sizes. If a cut is deep or infected see your GP. If you have had ulcers previously, see your healthcare team regardless of the size and depth of the wound. 

Film island dressings, such as Cutifilm Plus or Opsite Post Op, are for shallow cuts or grazes. The island part of the dressing is non-stick and is covered by an adhesive film. The film is waterproof so you can bathe without getting the wound wet. 

Primapore or Cutiplast dressings also have a non-stick wound contact layer but are covered by a stretchy fabric material that can move with body parts such as knees and elbows. Make sure the non-stick part of the dressing is bigger than your wound. Some dressings can be left on for seven days undisturbed to assist healing. These dressings absorb a small amount of weeping but if your wound is weeping larger amounts of fluid see your GP. 

If you have fragile skin the adhesives in island dressings may damage your skin. Instead, try a non-stick dressing such as Melonin or Cutilin. Place the plastic down on the wound and keep in place with a light crepe bandage, a self-adhering wrap such as Primagauze, or E.Z. BAN Wrap Cohesive Elastic Bandage. Wraps and bandages should never be tight enough to restrict blood flow. Allevyn gentle border is also suitable for fragile skin.  

Silicone coated dressings, such as Allevyn and Mepilex, are gentle and minimise pain without sticking to the wound, making them suitable for fragile skin. These are designed to be kept on your wound for a week and can be cost effective compared to multiple dressing changes. 

When to seek medical attention 

If you are not sure about a wound, seek medical attention. Delayed care with wounds and burns can lead to ulcers that are much harder to heal.