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Booster Shots

Cut (and Not-So-Dried) Care

January 14, 2002|ROSIE MESTEL

You may have heard the wisdom that one shouldn't cover cuts and scrapes with Band-Aids and gauze and the like but keep them exposed to the air so they can "breathe" and heal faster. I dutifully followed these instructions not long back after cutting my foot--which led to a pathetic, monthlong merry-go-round of the cut nearly healing then re-cracking, nearly healing then re-cracking, over and over again.

And now I learn that I gained nothing from all the pain, whining and (I'll admit) a certain amount of exaggerated limping to solicit sympathy. Exposing my cut to the cruel and desiccating air slowed the healing of my heel.

Wounds--even if they're not in a crack-prone location--heal faster when they're moist. They heal less painfully when moist. And they're less likely to form a visible scar.

The reason for this is not exactly rocket science, says wound-healing expert Dr. Warren Garner, whom we called to consult on the matter.

Wounds, after all, are healed through the action of certain cells in our body--which cleverly realize there's a breach in that body's hull and spring into action to plug it and repair it.

"Cells like to live in a wet environment, so they work better in a wet environment," says Garner, an associate professor of plastic surgery at USC's Keck School of Medicine. This moist-healing rule applies to your everyday, unserious wounds such as the one on my foot and the periodic scrapes that Garner's kids sustain (which are quickly plied with antibiotic cream, then a Band-Aid). It also applies to the serious, long-lingering ones that Garner and other wound experts treat.

These days, most in the medical community know that wounds should heal moist. But it wasn't always so. From ancient Greece far into the 20th century, dryness was deemed best. Then--starting with experiments in the '60s--scientists put this premise to the test. Using pigs and then humans, they measured how fast wounds healed when uncovered or kept moist and at last discovered the truth. Still, UCLA nurse practitioner Deborah Caswell (who specializes in wound treatment) recalls old-fashioned days of treating wounds with sunlamps to get them nice and dry. And more than just sunlamps.

"We used to put Mylanta on chronic wounds. We used to coat them with sugar," she reminisces. There's a rationale for some of this: Sugar, for instance, can impede the growth of bacteria (though neither Garner nor Caswell recommends trying it). She's not quite sure why the Mylanta was used. "Not everything we do--contrary to popular belief--is based on good science," Caswell says. "A lot is based on what we've always done."

Our curiosity piqued, we asked Garner for a step-by-step primer on wound healing. How's it done? Garner, who has recently been writing whole chapters on just this subject, obligingly gave us a very-much-briefer synopsis.

* First comes the all-important step--the plugging of holes in broken blood vessels, courtesy of the platelets and a blood protein called fibrin, so we don't bleed to death. (That's where the scab comes from.) This happens within minutes.

* Next--within hours--immune cells move in to kill any bacteria that might have gotten into the wound. The first arrivals are pretty single-minded: They simply concentrate on wiping out bacteria. But ones arriving later are much fancier and not only kill germs but start oozing chemicals into the surrounding tissue.

* When skin cells nearby sense those chemicals, they heed the cry for help and start slithering their way to the site of the wound. They begin dividing to fill up the gap. And tiny blood vessels start growing toward the wound.

* Finally, that mass of busily dividing cells is remodeled into a proper, skinlike structure, but it will never return completely to normal (you may notice, for instance, that your scars lack hairs).

Normally, people heal up without a hitch. But some people have wounds that can linger--such as people who are malnourished or have poor blood circulation, diabetes, infected wounds, varicose veins or extensive damage.

Finally, a public service announcement: If you have a wound that hasn't healed after three weeks, Garner urges you to skip any experiments with sugar and take it to the doctor.

*

If you have an idea for a Booster Shots topic, write or e-mail Rosie Mestel at the Los Angeles Times, 202 W. 1st St., Los Angeles, CA 90012, or at rosie.mestel@ latimes.com.

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