When it comes to wound care, one of the most common questions is whether you should cover a wound or leave it open. There are pros and cons to both approaches, and the best option will depend on the type and severity of the wound. In this article, we’ll go over the key factors to consider when deciding whether to bandage or leave a wound uncovered.
Quick Answers
Here are quick answers to common questions about covering vs. leaving wounds open:
- Minor cuts and scrapes – Usually best to leave uncovered so the wound can dry out and form a scab. Covering minor wounds can trap in moisture and bacteria.
- Major wounds – Usually best to cover major wounds with a sterile bandage to protect from infection and promote healing.
- Burns – Cover first and second-degree burns with a sterile non-stick bandage. Leave third-degree burns open.
- Surgical wounds – Cover surgically closed wounds with a sterile dressing for protection. Follow your doctor’s instructions.
- Draining wounds – Cover draining wounds with absorbent dressings to wick away moisture and contain drainage.
- Infected wounds – May need to leave open to drainage and air exposure. Consult your doctor.
Factors to Consider
When deciding whether to cover or leave a wound open, here are some important factors to take into account:
- Type of wound – Minor cuts and scrapes usually do better uncovered. Major wounds like deep cuts or surgical incisions typically need to be covered.
- Depth – Shallow, superficial wounds can often be left open to the air. Deeper wounds need protection and a moist healing environment that bandages provide.
- Location – Areas prone to irritation or contamination like the hands or joints are best covered. Wounds on the torso can often be left open.
- Drainage – Wounds with significant drainage need absorbent dressings to manage fluids and avoid maceration.
- Infection risk – Highly contaminated wounds may need coverage and topical antibiotics to prevent infection.
- Healing stage – Covering typically preferred in the early stages. Leaving open can help toughen skin as wound heals later on.
Benefits of Leaving a Wound Open
There are some advantages to leaving certain wounds uncovered as they heal:
- Allows wound to dry out and form scab – Evaporation helps create a dry protective crust.
- Prevents over-moisturizing – Excess moisture can lead to maceration and infection risk.
- Promotes epithelialization – Drying stimulates new skin cell growth.
- Allows for air circulation – Oxygen exposure helps healing and limits bacteria.
- Enables wound inspection – Can monitor healing and watch for signs of infection.
- Reduces disruption of scar tissue – Leaving open minimizes contact that can disturb new growth.
In general, minor superficial wounds do well being left open to the air. The drying effect helps protect the wound while also allowing it to remain undisturbed as healing takes place.
Benefits of Covering a Wound
Covering wounds has some key advantages as well:
- Protects wound from trauma and contamination – Creates a protective barrier.
- Absorbs drainage and exudate – Manages wound fluids to prevent maceration.
- Provides ideal moisture balance – Maintains a moist healing environment.
- Promotes granulation – Supports new tissue formation needed to fill wound.
- Allows for wound debridement – Autolytic debridement occurs under dressings.
- Provides thermal insulation – Maintains ideal wound temperature to aid healing.
- Limits pain and discomfort – Creates a cushion between wound and outside environment.
Covering larger, deeper wounds helps shield the area from disruption and supplies moisture while also absorbing excess drainage. This facilitates the ideal healing environment in many cases.
When to Leave a Wound Open
Here are some instances when it may be appropriate to leave a wound open:
- Minor cuts, scrapes, or abrasions
- First and second-degree burns less than 3 inches diameter
- Superficial wounds after debridement or cleansing
- Areas prone to moisture build-up and maceration
- Late stages of healing to toughen skin
- Wounds with minimal drainage
- Infected wounds needing air exposure
The open air environment helps create a dry, protective scab and prevents over-moisturizing for these types of wounds. Allowing the wound to breathe can also be beneficial for infected wounds.
Tips for Leaving Wounds Open
- Cleanse wound initially and apply thin layer of ointment if needed.
- Keep wound moisturized by reapplying ointment 1-2 times per day.
- Trim any loose flaps of skin or scabs gently.
- Check wound daily for signs of infection like redness or pus.
- Avoid trauma or irritation to the open wound.
- Once a scab forms let it remain intact.
When to Cover a Wound
Here are some instances when covering a wound is recommended:
- Large, deep, or gaping wounds
- Surgical incisions or trauma wounds
- Skin tears or flap wounds
- Burns greater than 3 inches in diameter
- Wounds with heavy drainage or exudate
- High risk wounds prone to contamination
- Early stages of healing to control bleeding and allow debridement
Covering these types of significant wounds helps control bleeding, manage wound fluids, reduce infection risk and provide an optimal moist healing environment.
Tips for Covering Wounds
- Cleanse wound and apply antibiotic ointment if prescribed.
- Select a sterile bandage or dressing appropriate for the wound type and amount of drainage.
- Change dressings frequently to manage exudate and inspect wound.
- Look for signs of infection like increasing pain, swelling or redness.
- Allow air exposure for 15-20 minutes when changing dressings.
- Loosen bandage if swelling occurs to maintain circulation.
Special Considerations by Wound Type
Burns
First degree and superficial second degree burns less than 3 inches diameter can often be left open after initial cleaning and application of a thin ointment layer. Larger burns or those on mobile areas of the body should be covered with a sterile, non-stick dressing.
Third degree burns should always be left open after debridement in order to monitor for infection prior to skin grafting. Avoid using topical creams or ointments on severe burns.
Surgical Wounds
Post-op incisions have a high risk of contamination and are best kept covered for at least the first 24-48 hours. Apply a sterile dressing immediately after surgery, changing it regularly to manage drainage and check wound status.
After the initial healing phase, a surgical incision may be left open to air during the day but covered at night for added protection and to prevent discomfort from clothing or bedding rubbing on the wound.
Skin Tears
Skin tears often involve a flap of tissue that needs to be positioned properly for optimal healing. These wounds require a covered, moist environment. Choose a non-adherent silicone dressing so the flap can be repositioned without re-injury when changing bandages.
Diabetic Foot Ulcers
Due to underlying circulation issues, diabetic foot ulcers are at very high risk of complications if not properly covered and offloaded. Use a protective diabetic shoe or boot along with frequent dressing changes. Monitor for signs of infection closely.
Venous Stasis Ulcers
Venous ulcers on the lower legs have high drainage and require absorbent dressings to wick away exudate while protecting the peri-wound skin from maceration damage. Compression wraps also help drain fluid from the area while decreasing edema.
Signs of Infection
It’s important to monitor all wounds routinely for any signs of infection, whether they are covered or open. Contact your doctor promptly if you notice:
- Increasing pain, swelling, warmth at the wound
- Redness spreading from the wound edges
- Green, yellow, or foul-smelling pus drainage
- Fever or flu-like symptoms
- Red streaking away from the wound
If substantial drainage or odors are present, uncover the wound for 20 minutes a few times a day to air it out and visually inspect. This may help avoid a missed infection.
When to Seek Medical Care
Consult a healthcare provider if:
- You have a major wound, burn, or post-surgical incision
- Signs of wound infection develop
- A wound shows no signs of healing after 1-2 weeks
- A chronic wound worsens or fails to improve with self-care
- A skin tear involves a large, dangling flap of tissue
- You have an underlying medical condition like diabetes that impairs healing
- Necrotic black tissue or malodorous drainage is present
For serious wounds or burns, urgent medical care is advised. With proper wound assessment and treatment, your provider can guide optimal covering versus air exposure to promote healing.
Conclusion
Deciding whether to cover or leave a wound open requires assessing factors like the type, depth, location, drainage, and stage of healing of the wound. Minor, superficial wounds typically do best being left open to the air to dry out and form a scab. Deeper, larger wounds need a protective, moist environment that bandages help provide.
It’s ideal to leave wounds open that have minimal drainage and are at low risk for contamination or trauma. High exudate wounds require dressings to absorb drainage. Covering is also important early in the healing process, whereas leaving wounds open can help toughen skin as healing finishes.
Regardless of whether a wound is covered or open, close monitoring for signs of infection is essential. With proper care and treatment guided by medical professionals when needed, wounds can heal more quickly and safely, with minimized scarring.
