It’s just a flesh wound

Tips for new wounds and scars

A small stream of obscenities flowed from my mouth as I felt the sudden jarring of my head against an unseen metal shelf that was sticking out of the wall in the narrow hallway. It was the same color as the wall. I never saw it. As they say, and as most of us have experienced: head wounds really bleed.

Red, dripping, soon sticky, and bizarrely smelling of rust.

Did you know that the rusty/copper smell of blood is mostly produced by the interaction of Fe²⁺ ions of iron with other substances on our skin? How interesting.

I held firm pressure for about a minute just to slow it down. In the mirror I discovered a 2 inch blunt force scalp laceration, fortunately above my hairline. The wound edges could be better approximated with stitches, but I could probably get away with steri-strips. Who wants to go to the ER while on vacation in another country?

Want to make a scene and grab attention? Walk out of a public bathroom holding bloody paper towels to your head, keep dripping on the floor, and ask the restaurant person to please consider relocating their camouflaged, head level, tapered edge, shitty bookshelf from where it currently lies in wait down a dark and narrow hallway. Please? If only for the next tall guy? To make my accident useful?

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So here is what I did and plan to do for my senseless head wound. I’m not a wound care specialist, but rather a primary care doc… so feel free to chime in!

Irrigate

I flushed the wound under running water in the bathroom sink immediately. It was a bloody mess in the sink. Fortunately my last tetanus shot was only a year ago. I don’t use hydrogen peroxide because it damages our tissues as well as the bad guys.

Hold pressure

I held pressure firmly for about 5-10 minutes, then light pressure for another 20.

Approximate wound edges

Stuff heals better when the edges are close. Once the bleeding was down to a slow ooze I asked my wife to throw on some steri-strips to better pull things together. It was tricky doing this in my hair but she got the job done. It’s helpful if your wife is an Ob/Gyn and can reassure you when stitches are not necessary. She sees way more blood on a daily basis. It’s also helpful if your daughter acts as her scrub tech, aiming the iPhone light and helping mom while showing good composure around blood.

Knowing whether you need stitches or not is best left to medical professionals. But basically if you push the edges of the wound together and it looks like that closes a gap, you probably need a little help.

Keep reinforcing wound edges together, and consider with your doctor whether a dash of topical steroid might help in certain situations

According to an UpToDate reference on this subject:

The wound should also be fixed (eg, with paper tape) to avoid strong tension on the wound. If a new scar shows any signs of ongoing or relapsing inflammation (eg, appearance of small indurations/hardenings), topical corticosteroids that dampen the inflammation should be started as soon as possible and maintained until the induration has resolved.

In a small randomized trial evaluating the efficacy of paper tape application to support cesarean section wounds versus no treatment, the risk of developing a hypertrophic scar was nearly 14-fold greater in the no treatment group than in the paper tape group [56].

Apply ice pack

Oh yeah, my head hurt. An ice pack for 20 minutes felt good. Many hotels will hook you up.

Wait a couple days, be patient

As they say, and as most of us have experienced: head wounds heal pretty quickly. I watched myself for concussion symptoms and also to make sure I had no evolving signs of a deeper bleed. Unlikely, given my age and mechanism of injury. But you never know.

Keep the area dry for 24 hours, then keep water time on the wound brief. Simple soap and water works.

I’m using shampoo because it’s my head after all, but not scrubbing anywhere near the wound. Just some gentle patting and rinsing. Not much blood anymore.

Try not to stretch the area

It’s important not to reopen or physically stress the area with bending, rubbing, or stretching when possible, especially high tension areas like the chest and abdomen. Otherwise this creates additional inflammation and mechanical stresses on the regenerating tissue matrix, and can lead to thick scars. In people prone to forming keloids, experts recommend stabilizing the area for 3-6 months.

Moisturize the healing wound/scab

Right now I’m just using some generic moisturizing cream. I also like Medihoney.

But in the long game I am partial to silicone-based scar creams. I’ve been meaning to do a post on silicone (polysiloxane) ever since a plastic surgeon’s consultation note to one of my patients validated this: “Okay to use silicone scar cream/sheeting 2 weeks postop.”

The brand I use with significant gashes that are likely to scar is called ScarAway. Available on Amazon and elsewhere I’m sure. I have no conflict of interest.

Do silicone creams actually work? There is not great quality evidence either way to answer this question. If you consult the Cochrane review on the subject you find this uninspiring conclusion:

We are uncertain whether the use of silicone gel sheeting compared with no treatment, treatment with non-silicone gel sheeting or intralesional injections of triamcinolone acetonide makes any difference…

And yet another paper I read about silicone posited these potential mechanisms of action by which polysiloxanes might help:

1. Increases hydration of stratum corneum and thereby facilitates regulation of fibroblast production and reduction in collagen production, while allowing scar “to breathe.”

2. Protection of scarred tissue from bacterial invasion and bacteria-induced excessive collagen production.

3. Modulation of the expression of growth factors, fibroblast growth factor β (FGF β) and tumor growth factor β (TGF β). This helps to balance fibrogenesis and fibrolysis as the scar remodels.

4. A reduction of itching and discomfort associated with the scarring process.

Silicone sheets have been studied more than creams/gels. The sheet itself can provide some skin stabilization, but is cumbersome to apply especially in the summer when sweat may dislodge the sheet. And for a head with hair it’s a bad idea. Gels should be fine.

Avoid UV and tanning

Plastic surgeons and dermatologists recommend covering the fresh scar for 6-12 months, or at least using sunscreen and minimizing exposure. Fresh scars are pink, and with UV light from the sun will turn darker as hyperpigmentation results. Guess I’ll be wearing my baseball cap this summer more than I had planned.

Accept scars

Ultimately a scar is a story. All of us have them, and telling their stories can be illuminating and empowering.

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Take good care, and hope to catch you next week :)