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Wound

Wound

Description

Wounds are bodily injuries caused by physical means resulting in breaks in the continuity of soft parts of the body structures. Trauma to these body tissues can result in bleeding and infection.

Types of wounds include:

AbdominalOrdinary
BulletPenetrating
ContusionPerforating
FishhookPoisoned
IncisedPuncture
LaceratedSubcutaneous
NonpenetratingTunnel
Open



Treatment for a wound is directed towards the complications. This includes removing foreign objects, stopping hemorrhages, and minimizing shock. Antiseptics and tetanus toxoid boosters are also used. If a person has not previously been immunized, the individual may be given tetanus immunoglobulin. Equine forms may be used if the former type is not available but the individual should be tested for hypersensitivity.

Causes

Any violence or trauma to tissues, including:

Bullets or any other projectiles
Surgery
Bites
Knife stabs or cuts
Fishhooks
Daggers, ice picks, and needles

Signs & Symptoms

Any break in the continuity of the skin or other soft parts of the body.

Nutritional Supplements

Structure & Function: Antioxidants

---------------------------------
General Supplements
---------------------------------

AdultChild/Adolescent
Aloe vera*
Arginine 500 - 1000 mg 200 - 800 mg
Chlorella*
Fish oils 3 - 5 g 2 - 3 g
EPO 1 - 3 g 1 - 2 g
B-Complex hi-potency hi-potency
Vitamin C1000 - 3000 mg 500 - 2000 mg
Vitamin E (Oral) 400 - 800 IU 200 - 400 IU
Zinc 20 - 100 mg 10 - 50 mg



* Please refer to the respective topic for specific nutrient amounts.

Note 1:

Vitamin E (as tocopherol) may also be applied topicallly.

Discussion:

Anabolic therapy is agreed upon but a variety of protein supplements are used, separately and in combination: these include: arginine, glutamine. leucine, iso-leucine, ornithine and valine.

It is also interesting to note that patients in one study reported enhanced mood with glutamine.

Note 2: All amounts are in addition to those supplements having a Recommended Dietary Allowance (RDA). Due to individual needs, one must always be aware of a possible undetermined effect when taking nutritional supplements. If any disturbances from the use of a particular supplement should occur, stop its use immediately and seek the care of a qualified health care professional.

Dietary Considerations

Wounds heal with a great expenditure of energy and nutrients. Nutritional management is aimed at meeting this demand through adherence to a Protein Enriched Diet or Immune Strengthening Diet, with arginine and vitamin A supplementation.

Wound healing is a dynamic biologic process of repairing insults to the integumentary system. It is commonly divided into three phases: inflammatory, proliferative, and maturation. Each phase has unique cellular and substance constituents without which it cannot progress normally.

Wound healing is also dependent upon support systems, notably: metabolic, immune and endocrine.

Most individuals experience a marked weight loss during the initial healing phase. Some of this loss can be attributed to a decreased intake of food. This often results from appetite loss or from the discomfort associated with physical movement. Much of the decrease in body weight arises from the catabolism of muscle to meet the accelerated needs of the body for protein.

Children are most vulnerable to catabolism, given their smaller size and growth hormone can provide dramatic improvement during wound healing, such as following burns.

For example, despite ingesting 40-60% of their estimated nutritional requirements, wound patients lost as much weight after three weeks as people undergoing full starvation. The interpretation of this finding was that healing wounds require energy and protein expenditures above those spent on maintaining healthy tissue. Dietary protein is essential during all of convalescence. During the first two to six weeks of healing, protein is needed to mount the immune response and to effect healing.

There is an increased synthesis of white blood cells for combatting infection. These cells in turn use protein for forming antibodies, and other host-defense factors. Cells proliferate at the injury site and mend the wound.

If the diet does not provide sufficient calories or exogenous protein at this time, the body breaks down endogenous protein, usually muscle, to fuel these metabolic processes. In the weeks which follow, the body attempts to replace the diminished protein stores and repair the damaged muscle. There is still need for a Protein Enriched Diet at this stage. If diet is insufficient, wounds which are late in healing may become protein donors for the rest of the body. In this case, the wound may never heal well. Supplements of arginine are effective in promotion of wound healing, aiding in collagen synthesis and diminishing post-traumatic weight loss. Supplemental arginine has been proven to diminish negative nitrogen balance in individuals following elective surgery.

In rats and mice fed nutritionally balanced chow, supplemental vitamin A accelerated wound healing in normal rats and rats with fractures, promoted rapid inflammatory response to wounds, increased the number of macrophages which were attracted to an injury site, prevented thymic involution after injury, and prevented usual impaired healing occuring in diabetic mice. It is suggested that wound patients be given supplementary vitamin A.

It is equally important to assess how nutrients are to be delivered, as to decide upon which nutrients to deliver. Unfortunately, both topics are beset by contradictory studies and contentious views.

While an oral diet may be the preferred route so far as most patients are concerned, specific concentrations of nutrients may be more easily estimated when delivered enterally (i.e. tube feeding). While the small intestine is the most popular route, the stomach may also be selected.

A glucose IV has become standard practice, however, a refinement, a glucose-xylitol combination has achieved better results in some studies.

Studies have also pointed out that a patient need not be malnourished in order to benefit from total parenteral nutrition.

No matter which nutrients are selected, nor what method is chosen, there must be on-going patient assessment in order to achieve the best results from nutritional pharmacology.

Homeopathic Remedy

Arnica montana tinct. - 30C
Calendula officinalis - tincture to 15C

Treatment Schedule

Doses cited are to be administered on a 3X daily schedule, unless otherwise indicated. Dose usually continued for 2 weeks. Liquid preparations usually use 8-10 drops per dose. Solid preps are usually 3 pellets per dose. Children use 1/2 dose.

Legend

X = 1 to 10 dilution - weak (triturition)
C = 1 to 100 dilution - weak (potency)
M = 1 to 1 million dilution (very strong)
X or C underlined means it is most useful potency

Asterisk (*) = Primary remedy. Means most necessary remedy. There may be more than one remedy - if so, use all of them.


References

Boericke, D.E., 1988. Homeopathic Materia Medica.

Coulter, C.R., 1986. Portraits of Homeopathic Medicines.

Kent, J.T., 1989. Repertory of the Homeopathic Materia Medica.

Koehler, G., 1989. Handbook of Homeopathy.

Shingale, J.N., 1992. Bedside Prescriber.

Smith, Trevor, 1989. Homeopathic Medicine.

Ullman, Dana, 1991. The One Minute (or so) Healer.

Herbal Approaches

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Herbs
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Cayenne
Gotu kola
St. John's Wort

German Commission E:

Calendula flower
Echinacea Purpurea
Hay Flower
Horsetail herb
Peruvian balsam

Note: The misdirected use of an herb can produce severely adverse effects, especially in combination with prescription drugs. This Herbal information is for educational purposes and is not intended as a replacement for medical advice.

Discussion:

Somewhat surprisingly, Cayenne may be applied directly to a wound, to stop bleeding, as well as taken internally to counter shock.

Tissue healing may be aided by the use of Gotu kola (25 mg b.i.d.) which seems to support the integrity of collagen. Studies have covered a wide range of wounds, including surgical as well as ulcerations. It has been used for leprosy in India.

St. John's Wort has a long history of traditional use as well as having demonstrated antibacterial and wound healing activity more recently.

These herbs have approval status by the German Commission E regarding their wound healing action:

Calendula (Marigold) flower
Chamomile flower (German)
Poplar bud
Sweet clover

References:

Blumenthal, M (Ed.): The Complete German Commission E Monographs: Therapeutic Guide to Herbal Medicines. American Botanical Council. Austin, TX. 1998.

Hobbs, C: St. John's Wort, Hypericum Perforatum. HerbalGram, 1989, 18/19:24-33.

Sevin, P: Some observations on the use of asiaticoside (Madecassol) in genral surgery. Prog. Med. (France) 1962, 90:23-24.

Aromatherapy - Essential Oils

Cuts:

Chamomile Essence,Clary Sage,
Eucalyptus Essence,Geranium Essence,
Lavender Essence,Rose Essence,
Tea Tree Essence.



Wounds

Angelica Essence,Benzoin Essence.



Related Health Conditions


acute renal failure
appendicectomy
Bleeding
cholecystectomy (gallstones)
hip replacement
Infection
malnutrition
organ transplant e.g. liver
spine surgery
stress

Notes:

In acute renal failure, due to uremic symptoms, it was thought necessary to restrict protein. However, this is now deemed to be unnecessary and contributes additional morbidity.

In appendicectomy it may be standard practice in some hospitals to institute IV therapy. This is deemed to be unnecessary.

In hip replacements, especially bilateral cases, infection is at high risk.

Malnutrition affects most hospital patients, sooner, rather than later, indeed half are malnourished upon entering the hospital. Thereafter, the hospital represents a sub-optimal nutritional environment. Not only might the patient have little appetite for meals, adequate nutrition may not have been represented in the whole meal, anyway.

In organ transplant e.g. liver the prolonged hospital stay is associated with infections and morbidity. IV therapy with glucose may seem inadequate but some studies have found that total parenteral nutrition actually increased the morbidity rate!

Stress and surgeries may be considered together, indeed the term: "surgical stress" has been coined. Basically, the patient enters a hyper-metabolic state; energy and nutrient requirements, therefore, are increased.

Abstracts

References

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