Sterile Water vs Saline: Wound Care [2024]

In wound management, the choice between sterile water and normal saline remains a critical decision for healthcare providers, impacting patient outcomes and infection rates. The World Health Organization (WHO) acknowledges the importance of accessible and affordable wound irrigation solutions in diverse healthcare settings. Normal saline, characterized by its isotonicity, closely mirrors the body’s physiological fluid, thereby minimizing cellular damage during irrigation. Conversely, sterile water, while hypotonic, presents a cost-effective alternative, especially in resource-limited environments where budgetary constraints are a significant consideration for organizations such as Médecins Sans Frontières. Understanding the nuanced differences between sterile water vs normal saline for wound care is essential, as highlighted in the most recent guidelines published in the Journal of Wound Care, influencing best practices in clinics and hospitals globally throughout 2024.

Wound irrigation stands as a fundamental pillar in the comprehensive management of wounds. It is far more than a mere cleansing step; it’s a targeted intervention designed to optimize the wound environment.

At its core, wound irrigation involves the application of a fluid solution to the wound bed. This process serves several critical purposes:

• Debris Removal: Irrigation effectively washes away foreign materials. This includes dead cells, dirt, and other contaminants that can impede healing.

• Bacterial Load Reduction: Irrigation helps to minimize the presence of bacteria within the wound. This reduces the risk of infection.

• Moist Wound Environment: Maintaining adequate moisture is crucial for cellular migration. It also facilitates enzymatic activity, both essential for tissue repair.

The Decisive Role of Solution Selection

The selection of an appropriate irrigation solution is not arbitrary. It is a critical decision that can significantly influence the trajectory of wound healing. The wrong choice can lead to complications. This ranges from delayed healing to severe tissue damage or infection.

Conversely, a judicious selection, aligned with the specific characteristics of the wound, can foster an environment conducive to rapid and effective healing.

Factors such as the wound type, depth, presence of infection, and patient-specific considerations all contribute to this decision-making process.

Scope of This Review

This editorial review aims to provide healthcare professionals with a comprehensive overview of commonly used wound irrigation solutions. We will delve into the nuances of each solution. This includes its properties, applications, advantages, and potential drawbacks.

The scope of this review encompasses:

• Commonly Used Solutions: We will examine frequently employed irrigation solutions, such as sterile water, normal saline, and antiseptic solutions.

• Application Across Wound Types: The review will explore how different solutions are best applied in various wound scenarios. These include acute wounds, chronic wounds, and infected wounds.

• Key Considerations for Healthcare Professionals: Practical guidance will be provided for healthcare providers. This supports informed decision-making in the selection and application of irrigation solutions. The goal is to improve patient outcomes.

Irrigation Solution Spotlight: Examining the Most Common Options

Wound irrigation stands as a fundamental pillar in the comprehensive management of wounds. It is far more than a mere cleansing step; it’s a targeted intervention designed to optimize the wound environment.

At its core, wound irrigation involves the application of a fluid solution to the wound bed. This process serves several critical purposes: removing debris, reducing bacterial load, and facilitating the visualization of the wound.

The selection of an appropriate irrigation solution is paramount, significantly influencing healing outcomes and minimizing potential complications. Let’s explore the properties, advantages, and disadvantages of the most frequently employed irrigation solutions.

Sterile Water: A Basic Cleansing Agent

Sterile water, characterized by its hypotonicity, is a common choice for wound irrigation. It is free from additives and readily available, making it a convenient option in various clinical settings.

Benefits and Limitations

One of the primary benefits of sterile water lies in its simplicity and cost-effectiveness. It is suitable for general cleansing and irrigation of acute wounds, particularly when other solutions are contraindicated due to allergies or sensitivities.

However, sterile water’s hypotonic nature can be a limiting factor. In deeper wounds, the osmotic gradient between sterile water and tissue cells may lead to cellular swelling or lysis.

This can disrupt the delicate balance required for optimal wound healing. Therefore, caution is advised when using sterile water in extensive or deep wounds.

Appropriate Use Cases

Sterile water is most appropriate for:

• Initial cleansing of superficial, acute wounds.
• Irrigation of wounds in patients with known sensitivities to other solutions.
• Situations where cost-effectiveness and accessibility are primary considerations.

Normal Saline (0.9% Sodium Chloride): An Isotonic Alternative

Normal saline, a 0.9% solution of sodium chloride in water, stands out as a physiologically compatible irrigation solution. Its isotonicity mirrors the body’s own fluids, making it a gentle and effective choice for wound cleansing.

Advantages of Normal Saline

The isotonic nature of normal saline offers a significant advantage over sterile water. By maintaining osmotic equilibrium, normal saline minimizes the risk of cellular damage.

It supports a stable wound environment conducive to healing. This characteristic makes normal saline suitable for a broader range of wound types.

Suitability for Various Wound Types

Normal saline’s versatility makes it a preferred choice for irrigating:

• Chronic wounds, such as pressure ulcers and diabetic foot ulcers.
• Infected wounds, where its cleansing action helps to reduce bacterial burden.
• Deep wounds, where its isotonicity prevents osmotic stress on tissues.

Antiseptic Solutions: A Cautious Approach to Infection Control

Antiseptic solutions, including chlorhexidine and povidone-iodine, play a role in wound irrigation when infection is a concern. However, their use demands a cautious and evidence-based approach.

Dilution and Contact Time

The key to safely using antiseptic solutions lies in proper dilution. High concentrations can be cytotoxic, damaging healthy tissue and impeding healing.

It is imperative to adhere to recommended dilution guidelines to minimize the risk of cellular damage. Appropriate contact time is also a crucial consideration. Prolonged exposure can exacerbate cytotoxicity, while insufficient contact may not effectively reduce bacterial load.

Balancing Risks and Benefits

While antiseptic solutions can be effective in reducing bacterial counts, it’s essential to carefully weigh their potential risks and benefits. Evidence suggests that certain antiseptics may delay wound healing if used improperly.

Therefore, their application should be reserved for cases where infection is confirmed or strongly suspected, and used judiciously under the guidance of established protocols. In many cases, mechanical debridement and frequent irrigation with normal saline are more effective in managing bioburden without the risks associated with antiseptics.

Tailoring Treatment: Clinical Applications of Irrigation Solutions by Wound Type

Following a comprehensive understanding of available irrigation solutions, the subsequent crucial step involves effectively applying these solutions in real-world clinical scenarios. The selection of an appropriate irrigation solution is not a one-size-fits-all decision; rather, it demands a nuanced understanding of the specific wound type, its characteristics, and the patient’s overall health status.

This approach ensures that the chosen solution optimally supports the healing process, minimizes potential complications, and aligns with the unique needs of each individual.

Acute Wounds: Immediate Care and Irrigation Protocols

Acute wounds, characterized by their sudden onset and relatively short healing timeframes, demand immediate and effective intervention. These wounds, often resulting from trauma or surgical procedures, require careful irrigation to remove debris, reduce bacterial contamination, and promote optimal healing conditions.

Lacerations and Abrasions

Lacerations and abrasions, common types of acute wounds, require thorough irrigation to prevent infection. For lacerations, the focus should be on removing any foreign material embedded within the wound. Abrasions, which involve the superficial removal of skin layers, are particularly susceptible to contamination.

Normal saline is generally the preferred solution for irrigating these types of wounds due to its isotonicity and biocompatibility.

The irrigation technique should involve a steady stream of fluid, applied with sufficient pressure to dislodge debris without causing further tissue damage.

Surgical Incisions

Surgical incisions, while created under controlled conditions, still require careful irrigation to minimize the risk of postoperative infection.

Sterile saline is typically used to irrigate surgical sites, both during and after the procedure. The goal is to remove any blood, tissue fragments, or contaminants that may have entered the wound during surgery.

Postoperative irrigation may be performed as part of routine wound care, following the surgeon’s specific instructions.

Chronic Wounds: Long-Term Management Strategies

Chronic wounds, defined as wounds that fail to heal within an expected timeframe (typically 3 months), present unique challenges for healthcare professionals. These wounds, often associated with underlying conditions such as diabetes, vascular disease, or pressure, require a comprehensive management approach that includes appropriate irrigation strategies.

Pressure Ulcers

Pressure ulcers, also known as bedsores, develop due to prolonged pressure on the skin, often in immobile patients. Irrigation plays a critical role in managing pressure ulcers by removing necrotic tissue, reducing bacterial load, and promoting granulation tissue formation.

Normal saline is commonly used for irrigating pressure ulcers. In some cases, antiseptic solutions, such as diluted povidone-iodine or chlorhexidine, may be considered to address infection, but only with careful consideration of potential cytotoxicity.

Diabetic Ulcers

Diabetic ulcers, a common complication of diabetes, often occur on the feet and lower legs. These wounds are characterized by impaired healing, increased susceptibility to infection, and poor circulation.

Irrigation is essential for managing diabetic ulcers by removing debris, controlling infection, and promoting tissue regeneration.

The choice of irrigation solution may depend on the presence of infection and the overall condition of the wound bed. Regular debridement is often necessary to remove necrotic tissue and promote healing.

Venous Leg Ulcers

Venous leg ulcers result from chronic venous insufficiency, leading to impaired blood flow in the legs. Irrigation helps in managing these ulcers by removing exudate, reducing bacterial contamination, and promoting venous return.

Normal saline is generally the preferred solution for venous leg ulcers. Compression therapy, along with appropriate wound care, is essential for promoting healing.

Infected Wounds: Combating Bioburden and Promoting Healing

Infected wounds represent a significant clinical challenge, requiring aggressive intervention to control infection and promote healing. Irrigation plays a vital role in managing infected wounds by removing bacteria, debris, and inflammatory mediators.

Solution Selection for Bioburden Management

The choice of irrigation solution for infected wounds should be based on the severity of the infection, the type of bacteria involved, and the patient’s overall health status.

Antiseptic solutions, such as diluted hydrogen peroxide, chlorhexidine, or povidone-iodine, may be considered to reduce bacterial load. However, it is crucial to use these solutions with caution, as they can be cytotoxic to healthy tissue if used improperly.

Debridement and Antimicrobial Therapy

Infected wounds often require debridement to remove necrotic tissue and expose the underlying healthy tissue to irrigation and antimicrobial therapy. Debridement can be performed surgically, mechanically, or enzymatically, depending on the characteristics of the wound and the clinician’s expertise.

Antimicrobial therapy, either topical or systemic, may be necessary to control infection and promote healing. The choice of antimicrobial agent should be based on culture and sensitivity testing to ensure effectiveness against the specific bacteria involved.

The Healthcare Team’s Role: A Collaborative Approach to Wound Irrigation

Tailoring Treatment: Clinical Applications of Irrigation Solutions by Wound Type Following a comprehensive understanding of available irrigation solutions, the subsequent crucial step involves effectively applying these solutions in real-world clinical scenarios. The selection of an appropriate irrigation solution is not a one-size-fits-all decision, and the collaborative efforts of the healthcare team are paramount to optimal patient outcomes.

The synergy among nurses, physicians, wound care specialists, and pharmacists ensures comprehensive wound management, with each role contributing uniquely to the irrigation process and overall care plan.

Nurses: Frontline Care and Assessment

Nurses are at the forefront of wound care, providing direct patient care and continuous assessment. Their role is crucial in identifying wound characteristics, implementing irrigation protocols, and monitoring patient responses.

Primary Responsibilities

Wound assessment is a fundamental nursing responsibility, involving the evaluation of wound size, depth, tissue type, exudate characteristics, and the presence of infection. Based on these assessments, nurses select appropriate irrigation techniques, frequencies, and solutions according to established protocols and physician orders. They also expertly manage dressing changes using sterile and aseptic techniques.

Monitoring and Education

Nurses vigilantly monitor for signs of infection, such as increased pain, redness, swelling, purulent drainage, or fever. They are also responsible for educating patients and their families on proper wound care techniques, including how to recognize signs of complications and when to seek medical attention. Thorough patient education empowers individuals to actively participate in their care, leading to improved outcomes.

Physicians: Complex Cases and Debridement Decisions

Physicians assume a pivotal role in managing complex wounds and making critical decisions about debridement procedures.

Decision Making for Advanced Wound Care

Physicians are responsible for determining the overall treatment plan, including the need for surgical intervention, advanced wound therapies, and specialized irrigation protocols. In cases where wounds are not responding to standard treatments, physicians may consult with wound care specialists or other healthcare professionals to formulate an alternative strategy.

Surgical Intervention and Advanced Procedures

When extensive debridement is necessary to remove necrotic tissue or address underlying complications, physicians perform surgical procedures to optimize the wound bed for healing. They provide oversight for the selection and application of appropriate irrigation solutions to support the healing process following debridement.

Wound Care Specialists: Advanced Techniques and Solution Expertise

Wound care specialists possess advanced knowledge and skills in managing complex and chronic wounds. Their expertise is invaluable in optimizing irrigation protocols and selecting the most appropriate solutions for individual patient needs.

Specialized Expertise in Irrigation Protocols

Wound care specialists are adept at employing advanced wound care techniques, such as negative pressure wound therapy, hyperbaric oxygen therapy, and specialized dressings. They provide expertise in selecting optimal irrigation solutions based on wound characteristics, bioburden levels, and patient-specific factors.

Collaboration and Consultation

Wound care specialists often serve as consultants to other healthcare providers, sharing their knowledge and expertise to improve patient outcomes. They collaborate with nurses, physicians, and pharmacists to develop individualized treatment plans that incorporate evidence-based practices and address the unique needs of each patient.

Pharmacists: Medication and Solution Compatibility

Pharmacists play a critical role in ensuring the safety and efficacy of wound irrigation practices through their expertise in medication and solution compatibility.

Ensuring Solution Safety and Compatibility

Pharmacists are integral in assessing the sterility and stability of irrigation solutions, ensuring they are free from contamination and appropriate for use. They assess potential medication interactions with irrigation solutions, preventing adverse effects and ensuring optimal therapeutic outcomes.

Optimizing Therapeutic Outcomes

Pharmacists contribute to infection control efforts by providing guidance on proper storage, handling, and disposal of irrigation solutions. Their expertise helps to mitigate the risk of contamination and healthcare-associated infections, supporting a safe and effective wound care environment.

Infection Prevention: Maintaining a Sterile Environment

Following a detailed consideration of healthcare team roles, we now turn our attention to infection prevention, a cornerstone of effective wound irrigation. Minimizing the risk of complications and healthcare-associated infections necessitates a comprehensive approach encompassing sterile technique, robust bioburden management, and careful consideration of cytotoxicity. The overarching goal is to maintain a sterile environment that supports optimal wound healing.

Sterile Technique: Minimizing Contamination

Strict sterile technique is paramount during wound irrigation to prevent the introduction of microorganisms that can lead to infection. This principle transcends mere procedure; it’s a foundational commitment to patient safety.

Maintaining a sterile field demands meticulous attention to detail. This includes using sterile gloves, drapes, and instruments. All materials that come into contact with the wound must be sterile.

Avoid reaching across the sterile field, and ensure proper hand hygiene before and after the procedure. Consider using a "no-touch" technique where possible.

Adherence to these practices dramatically reduces the risk of introducing pathogens and compromising the wound environment.

Cross-contamination is a significant concern in healthcare settings. Dedicated equipment for each patient and rigorous disinfection protocols are essential.

Implementing single-use irrigation solutions and preventing contact between contaminated surfaces and sterile supplies can help limit cross-contamination. Regular audits of sterile technique practices can help identify and address potential breaches, reinforcing a culture of safety.

Bioburden Management: Addressing Bacterial Load and Biofilms

Selecting appropriate irrigation solutions plays a critical role in effectively reducing bacterial load within wounds. The presence of bacteria, particularly in high concentrations, can impede healing and increase the risk of infection.

Antiseptic solutions, used judiciously and at appropriate dilutions, can significantly reduce the number of bacteria. However, it’s crucial to consider the potential for cytotoxicity, which will be discussed later.

Normal saline provides a mechanical flushing action that removes debris and loosely adherent bacteria. It offers a safe and effective baseline for irrigation.

Biofilms, structured communities of bacteria encased in a self-produced matrix, pose a significant challenge in chronic wound infections. These biofilms are highly resistant to antibiotics and host defenses.

Disrupting biofilms requires a multifaceted approach that combines mechanical debridement, irrigation, and antimicrobial agents. Regular debridement, both sharp and mechanical, is essential to physically remove the biofilm.

Certain irrigation solutions, such as those containing surfactants or chelating agents, may help disrupt the biofilm matrix, enhancing the effectiveness of antimicrobial agents. Furthermore, negative pressure wound therapy can assist in bioburden management.

Cytotoxicity: Understanding the Potential for Tissue Damage

Cytotoxicity, the capacity of a substance to cause cell damage or death, is a critical consideration when selecting irrigation solutions. While some solutions are effective at reducing bacterial load, they can also harm healthy cells, impeding the healing process.

Antiseptic solutions, in particular, can be cytotoxic if used at high concentrations or for prolonged periods. It is imperative to use these solutions at the recommended dilutions and contact times to minimize potential harm.

Sterile water, while generally considered safe, is hypotonic and can cause cell lysis (bursting) if used in large volumes or in deep wounds. Normal saline, being isotonic, is less likely to cause osmotic stress on wound cells.

The volume and pressure of irrigation can also contribute to cytotoxicity. Excessive pressure can damage delicate tissues. Gentle irrigation techniques are preferred.

When selecting an irrigation solution, it’s essential to weigh the benefits of infection control against the potential risks of tissue damage. A thorough assessment of the wound and the patient’s overall health is crucial to make an informed decision.

Key Concepts in Wound Care: Debridement, Osmolarity, and Healing

Having addressed the critical considerations of infection prevention, it is now essential to delve into the core concepts that underpin effective wound management. These concepts – debridement, osmolarity, and the stages of wound healing – are inextricably linked to wound irrigation practices and significantly influence patient outcomes. Understanding these factors enables healthcare professionals to optimize treatment strategies, promoting faster and more complete healing.

Wound Debridement: Preparing the Wound Bed

The relationship between wound irrigation and debridement is symbiotic. Debridement, the removal of necrotic tissue, debris, and bioburden, is paramount for creating a conducive environment for healing. Irrigation plays a vital role in this process.

It softens and loosens debris, making it easier to remove during sharp, enzymatic, or autolytic debridement procedures. Without adequate irrigation, debridement can be more difficult and potentially traumatic to the surrounding tissue.

Furthermore, irrigation helps to dislodge and flush away loosened debris, preventing it from accumulating and hindering the healing process. A clean wound bed is essential for cellular migration, angiogenesis, and the deposition of new extracellular matrix.

Therefore, irrigation should be considered an integral part of any debridement strategy. The selection of the irrigation solution can further augment the debridement process. Certain solutions, such as those containing surfactants, may aid in the breakdown of biofilms, facilitating their removal during debridement.

Effective debridement, supported by appropriate irrigation, creates a foundation for optimal wound healing.

Osmolarity: Balancing Fluid Levels

Osmolarity, the measure of solute concentration in a solution, is a crucial consideration in wound care. The osmolarity of irrigation solutions directly impacts the osmotic balance between the solution and the wound tissue.

Maintaining this balance is essential for preserving cell integrity and promoting healthy cellular function.

Solutions that are hypotonic (lower solute concentration than body fluids) can cause cells to swell and potentially rupture, while hypertonic solutions (higher solute concentration) can lead to cell shrinkage and dehydration. Isotonic solutions, such as normal saline, closely match the osmolarity of body fluids and are generally considered the safest option for wound irrigation.

However, the use of hypertonic solutions has been explored in some wound care protocols for their potential to reduce edema and draw fluid from the wound bed. This practice must be approached with caution, as it can also dehydrate healthy cells. Careful monitoring and assessment are necessary to ensure that hypertonic solutions are used judiciously and do not impede the healing process.

Ultimately, the selection of an irrigation solution with an appropriate osmolarity helps to maintain cellular homeostasis, supporting optimal wound healing.

Wound Healing: The Body’s Natural Repair Process

The body’s natural wound healing process is a complex and carefully orchestrated series of events. It is typically divided into distinct, overlapping phases: inflammation, proliferation, and remodeling.

Irrigation solutions can significantly influence each of these stages.

During the inflammatory phase, irrigation helps to remove debris and bacteria, minimizing the risk of infection and promoting a balanced inflammatory response. Controlling infection is crucial for transitioning to the next stage.

In the proliferative phase, new tissue forms to close the wound. Adequate moisture and a clean wound bed, achieved through effective irrigation, are essential for cell migration and angiogenesis.

Finally, the remodeling phase involves the maturation of the new tissue and the deposition of collagen to increase wound strength. Consistent wound care, including appropriate irrigation practices, supports the formation of a durable and functional scar.

The ideal irrigation solution promotes a moist wound environment. This facilitates cellular migration, reduces pain, and speeds up the healing process. By understanding how irrigation solutions interact with the stages of wound healing, healthcare professionals can make informed decisions that optimize patient outcomes.

Navigating the Guidelines: Best Practices and Regulatory Standards

Having addressed the critical considerations of infection prevention, it is now essential to delve into the core concepts that underpin effective wound management. These concepts – debridement, osmolarity, and the stages of wound healing – are inextricably linked to wound irrigation practices and the applicable guidelines.

Understanding and adhering to established guidelines and regulatory standards is paramount for healthcare professionals engaged in wound care. These standards, provided by organizations such as the CDC, WOCN, and FDA, ensure patient safety, promote best practices, and maintain quality control in wound management.

Centers for Disease Control and Prevention (CDC): Infection Control Recommendations

The CDC provides comprehensive recommendations for infection control, which are directly relevant to wound care and irrigation practices.

Adhering to these guidelines is crucial to minimize the risk of healthcare-associated infections (HAIs).

Key CDC Recommendations for Wound Care

• Standard Precautions: Implement standard precautions, including hand hygiene, use of personal protective equipment (PPE), and safe handling of sharps, for all patient interactions.
• Aseptic Technique: Employ aseptic technique during wound irrigation and dressing changes to prevent contamination.
• Environmental Cleaning: Maintain a clean and disinfected environment in wound care settings.
• Surveillance: Conduct surveillance for wound infections and implement appropriate control measures.
• Antimicrobial Stewardship: Practice antimicrobial stewardship to minimize the development of antibiotic-resistant organisms.
• Proper Waste Disposal: Follow guidelines for proper disposal of contaminated materials.

The CDC emphasizes meticulous hand hygiene before and after wound care procedures.

Using sterile gloves and other PPE appropriately is essential to prevent the transmission of pathogens.

Maintaining a clean environment and properly disinfecting surfaces are also critical.

Wound, Ostomy and Continence Nurses Society (WOCN): Guidance for Wound Management

The WOCN provides evidence-based guidance for best practices in wound management, including irrigation protocols.

These guidelines assist healthcare professionals in delivering optimal care and improving patient outcomes.

WOCN’s Best Practices for Wound Irrigation

• Assessment: Conduct a comprehensive wound assessment to determine the appropriate irrigation solution, pressure, and frequency.
• Solution Selection: Choose the irrigation solution based on wound characteristics, infection status, and patient factors.
• Irrigation Technique: Use appropriate irrigation techniques to remove debris, reduce bacterial load, and promote healing.
• Documentation: Document all aspects of wound care, including irrigation procedures, solution used, and patient response.
• Patient Education: Educate patients and caregivers about wound care, irrigation techniques, and signs of infection.

The WOCN recommends using sufficient irrigation pressure to remove debris without causing tissue damage.

Education plays a vital role in enabling patients and caregivers to participate actively in wound management.

Regularly updating knowledge on best practices is also essential for healthcare professionals.

FDA (Food and Drug Administration): Manufacturing and Labeling Standards

The FDA regulates the manufacturing and labeling of sterile water and normal saline solutions.

Compliance with these regulations ensures the safety and efficacy of these solutions.

Key FDA Regulations for Irrigation Solutions

• Sterility: Sterile water and normal saline solutions must be manufactured under sterile conditions to prevent contamination.
• Labeling: Labels must accurately reflect the solution’s contents, concentration, and intended use.
• Purity: Solutions must meet stringent purity standards to minimize the risk of adverse reactions.
• Packaging: Packaging must maintain the sterility and integrity of the solution until use.
• Adverse Event Reporting: Manufacturers are required to report any adverse events associated with their products.

The FDA’s regulations ensure that healthcare professionals can trust the quality and safety of sterile water and normal saline solutions.

Proper storage and handling of these solutions are also essential to maintain their integrity.

Furthermore, it is important to note that the FDA has specific requirements for medical devices used in wound irrigation, such as irrigation syringes and catheters.

By adhering to the guidelines and regulations set forth by the CDC, WOCN, and FDA, healthcare professionals can provide safe, effective, and evidence-based wound care, ultimately promoting optimal patient outcomes and minimizing the risk of complications.

So, there you have it! When it comes to sterile water vs normal saline for wound care, the choice really depends on the situation and what your healthcare provider recommends. Both are great options for keeping things clean and promoting healing, but knowing the nuances can help you make the best decision for your specific wound. Hopefully, this clears up any confusion!