An Open Wound Care Primer

“I’m going to excise your skin in the shape of a diamond, like the one I am outlining on your skin.”
My Dermatologist in 1988

My first excision

With that, Doctor “C” proceeded to excise a diamond-shaped portion of skin from my left forearm. This was no small diamond either. It was close to four inches from to top to bottom and a couple of inches across.

The value of "clear margins"

My dermatologist explained that she needed to do this so to make sure that I would have “clear margins”. In other words, the multiple centimeters of skin surrounding my melanoma had to be removed to have the best chance of getting all the cancer out. This seemed logical to me.

I was left with an open wound

I remember feeling fine that day even as the anesthetic wore off. I felt great, that is until I removed the actual bandage that covered the stitched-up incision. What did I find? Well, I discovered that my surgical site was not completely closed and somehow no one told me about that. I had a quarter-sized hole in my skin. Panic set it. I called my doctor and asked about the new-found cavern in my formerly, well-crafted arm.

The world of open wound care

At 24 years of age, I was not ready for this reality and was told that my skin was too tight to completely close. I was not elastic enough. I started trying to stretch the skin on my good arm and found that I was wound pretty tight, which would match my personality at that time as well. Welcome to the “open wound” world! I found some wound care instructions that I had wadded up in my jeans pocket and started caring for my arm.

I resigned to not using my arm

I kept the site as clean as possible using an antibiotic ointment to keep it moist. I kept it covered twenty-four hours a day for days on end. I slept on my back, which was quite a chore because I spent many nights on a rollaway bed at my girlfriend’s parents’ home. I basically did nothing active. I didn’t want anything to bump into it. My arm was like a treasured gem that happened to be attached to my torso. I didn’t even use it while driving.

This was all new to me

I was new to “open wounds." I'd had surgical procedures previously that resulted in completely stitched wounds, but this was something new, and I was not happy. I did a little research and found that these types of wounds require what is called “secondary healing.” That is they heal from the inside out and may be more prone to infection than “primary healing” wounds, which are completely stitched.

Here is some advice that I found related to open wound care for skin cancer. The list below summarizes a comprehensive treatment of various types of wound treatment that I believe is helpful and can be found here¹.

• Keep the wound clean. Remove the dressing with clean hands or gloves. Apply new dressing.
• Keep the wound moist. A dry wound will stick to dressing.
• Do not use disinfectants, hydrogen peroxide, iodine, or rubbing alcohol. These may actually be counterproductive and damage skin.
• Avoid swimming or baths. Shower with the head at least 12 inches from the wound.
• Gauze is more likely to cause pain than other products like hydrogels, hydro fibers, and other absorbent dressings.
• Reduce pain and swelling using over-the-counter medications.
• Watch for signs of infections, such as swelling, redness, and fever.
• Smoking, the use of steroids, and chemotherapy may reduce the body’s ability to heal.
• Protect the wound from jarring and pressure.
• Secondary healing takes more time and will likely produce more scarring than primary healing. Your wound may involve both types of healing as mine did.

My first open wound care experience didn't go too badly

Overall, I think I did a pretty good job with limited instruction. The wound healed pretty well with some scarring as was expected. I wish I had asked more questions prior to the surgery because that open wound was a shock to my system. Knowing what to expect would have helped me be more prepared. Hopefully, you will be a better patient than I was.

What are some of your tips for open wound care?