On Wetting Wounds

Physicians often recommend to their patients with fresh surgical wounds that they not get in the pool for a couple of weeks and not soak the wound in a tub for prolonged periods.  However, when I ask my colleagues why they offer this recommendation, they usually can’t explain it.   Or, at least, the explanations I receive are not consistent.

For example, some will say that the chlorine is harmful to healing tissues.  While that is true, chlorinated water – even in a pool – is relatively dilute.  Pure chlorine is certainly toxic and deadly, but the dilute chlorine in pool water is only threatening to bacteria.    It is also paradoxical that those who claim that chlorinated water is so harmful to wounds that they don’t want their patients in pools or tubs that they often seem to have no problem in using Dakin’s solution to treat open wounds. 

Dakin’s solution – first used in World War I – is sodium hypochlorite (i.e., bleach).  Surgeons have been using it for over a century to treat open wounds, especially burns.  It has excellent antibacterial properties, killing bacteria from a wide variety of species.  However, there is also old and new evidence that it may be harmful for healing tissues, although this effect may not reach the level of clinical significance. I’m not trying to denigrate Dakin’s solution – although I do have questions as to whether it really accomplishes anything, given that we don’t have any prospective controlled clinical trials on Dakin’s to guide our use. 

My point is that, if it’s OK to throw bleach into a raw open wound, why is it not OK for tap water or pool water to touch a primarily closed surgical wound?

Other caveats against soaking a wound include the potential to contaminate the wound with organisms that are growing in the water.  Now, of course, the chlorine in pool water is there to reduce the bacterial burden in the pool.  I suspect that the concentration of organisms growing on any one human being’s skin is higher than that of pool water (except, of course, those humans who just stepped out of a shower).  So I fail to understand how a relatively aseptic swimming pool could contaminate a surgically closed wound to any significant degree.  (If we’re talking about swimming in a smelly waterhole or swamp, of course, that would be a different story.)

What is also inconsistent is the fact that standard treatment for an anal wound — such as that following an incision and drainage of a perianal abscess — is to soak the wound for 20 minutes or so several times a day in a Sitz bath.  If it’s OK to soak this heavily contaminated open wound in tub water, why is it not OK to soak a primarily closed clean surgical wound in tub or pool water?

There are likely millions of animals on the surface of the planet that currently have open wounds.  They treat their wound by licking them.  Their wounds heal just fine.  And they heal without any wound packing, antiseptics, ointments, or dressings.  I contend that a shower, a bath, or getting into a pool are simply more civilized forms of licking.  It would be a paradigm shift in medicine for us to ensure that a healing wound be the cleanest part of the body (because it’s being washed) rather than the dirtiest.