What to do with hand wounds

Many therapists use a three-color wound classification system to aid in traumatic wound management and to evaluate the effect of therapy on healing and function. The goal is to eliminate black or necrotic tissue to facilitate the rapid progression to red or "beefy" granulating wound tissue that is capable of healing or suitable for grafting. The red wound is protected until wound closure. Mechanical d├ębridement with soap and water, pulsed lavage, frequent dressing changes, and whirlpool therapy are the most common methods used to maintain fragile developing granulation tissue while eliminating necrotic or infected debris. Although the goal is to achieve a healthy granulating bed, exuberant granulation tissue or "proud flesh" is the external manifestation of a richly perfused microvascular subsurface. Beefy red granulation tissue often is contaminated with bacteria, and cleansing is required to facilitate wound closure and grafting procedures. The ideal wound surface is a pale pink, smooth tissue bed characterized by brisk capillary refill.

Whirlpool therapy for mechanical debridement involves submerging the affected extremity into a bath of agitated water and injected air. To be effective, the water temperature should be between 33.3°C (92°F) and 35.5°C (96°F). Rinsing the open wound in clean water following agitated whirlpool treatment decreases bacterial counts; when this is followed by active motion and elevation, it can also reduce edema. The negative aspects of whirlpool therapy include the dependent position of the limb during treatment, the possibility of cross-contamination between patients using the same equipment, and the possibility of excessive debridement and destruction of healthy microvascular beds.

Ultrasound is used to facilitate healing and ROM; treat joint contractures, pain, and inflammatory conditions; and moderate scar formation. Ultrasound waves can be used to warm soft tissues at 1.0 to 1.5 W/cm2 (ie, thermal effect) to depths of 2 to 5 cm and are most helpful during the remodeling phase of wound healing. The proliferative phase of wound healing may be influenced by the nonthermal effects of ultrasound, at 0.3 to 1.0 W/cm2 . Although this healing effect has been demonstrated in the laboratory, the results of clinical trials are mixed with regard to the true potential for ultrasound to affect wound healing. Ultrasound increases membrane permeability. Used in conjunction with topically applied triamcinolone as a coupling medium, ultrasound can encourage collagenase activity and the breakdown of existing scar.