From: doyle+@pitt.edu (Howard R Doyle)
Subject: (Wounds)
Date: (old)

In article <Bw0vp7.n2J@unix.amherst.edu> akcobb@unix.amherst.edu
(acapella) writes:

>Ralph Yozzo (yozzo@watson.ibm.com) wrote:
>: 
>: As a followup question, (I realize that there is probably no ironclad rule.)
>: how much peroxide should one pour on a cut?  
>: And how often should it be done?  For example, should it be done once
>: or every day for the first few days while the cut heals.
>: 
>: And also what are the consequences of putting both iodine and peroxide
>: on a cut?
>
>Recently I had to get stiches for a large cut on my arm.  I told
>the ER doctor that I had put both H2O2 and Betadine (an iodine
>solution) on the wound in an effort to keep it clean, and he said
>that actually I shouldn't have done that.  No great harm done, but
>he said that people are beginning to be discouraged from pouring
>either of those directly on cuts--apparently they kill the cells
>as well as the germs and cause slower healing.


Very few areas in surgery are as influenced by one's religious beliefs
as wound care. Get 20 surgeons in a room and ask them how to manage a
given wound and you will get 40 answers.

The traditional methods, dipping limbs and whole patients in solutions
that sting, are very rarely supported by any experimental evidence.
But is hard to eradicate certain traditions.

Take iodine, for instance. It is a great antiseptic. It also kills 
everything else in sight. So it makes sense to use it to scrub intact
skin prior to surgery, but not to put into open wounds (you see, fibroblasts
are our friends, we want them to live long and prosper). The same can be
said about something called Dakins solution. It is very popular. It is also
just watered down Clorox with a little bicarbonate. But it smells good. And
it makes stinking wounds smell good. And bugs don't stand a chance when you
pour it onto something, but neither do other living cells, unless you dilute
the sodium hypochlorite to 0.5% (full strength Dakins is 12.5%).

I'm not convinced that there is anything better than plain saline-soaked
dressings for uncomplicated wounds. But that doesn't make us feel like we
are doing something, so we go for things that burn, or stain the clothes,
or smell good, or, better yet, bubble.

Now an infected wound is a different story. The infection has to be controlled,
or it will never heal. But this is better done by cleaning the wound 
surgically (i.e., debridement) and applying topical antibiotics, than by
cauterizing it, whether by chemical or thermal means.

As for burns, well that is a special type of wound that requires topical
antibiotics from the start. But we really don't want to get into that.


------------------------

Howard Doyle
doyle+@pitt.edu