Wound Care and Scar Management
What you must know
Understand wound healing phases and the factors that delay healing (infection, ischemia, diabetes, smoking, steroids, malnutrition). Know wound assessment - size, depth, tissue type, exudate, periwound skin, and signs of infection - and moist wound healing principles. Be familiar with dressing categories (films, hydrocolloids, foams, alginates, hydrogels, antimicrobials) and when each fits. For scars, know hypertrophic scar vs keloid (keloid extends beyond the original wound), and scar management: pressure, silicone, massage, positioning/splinting, and edema control. Know edema management (elevation, compression, retrograde massage) and desensitization for sensitive scars.
Traps in questions
- Dry wounds vs wet wounds: moist healing is preferred; a dry dressing on a clean granulating wound is usually wrong.
- Hydrogel adds moisture; alginate and foam absorb exudate - matching dressing to exudate level is a common question.
- Keloid vs hypertrophic: keloid extends beyond wound margins and recurs; hypertrophic stays within.
- Silicone is first-line for scar; pressure is used for burns and hypertrophic scarring.
- Infection signs (increasing pain, redness, warmth, purulent exudate, fever) require escalation, not just a dressing change.
Rule of thumb
Match dressing to exudate and tissue: add moisture to dry wounds, absorb from wet wounds, protect intact skin. For scars, start early with silicone, pressure if indicated, and massage once the wound is closed and stable.
Worked example
A healed burn scar on the dorsal hand is raised, firm, and itchy. Plan: silicone sheeting, scar massage, compression glove if tolerated, and stretching/splinting to preserve web space. Monitor for contracture and refer if range is lost.