Wound care is a hands-on skill that combines technical precision with clinical judgment. Medical assistants perform dressing changes, assist with wound assessments, and remove sutures and staples under provider direction. Getting this right protects the patient from infection and supports healing. Getting it wrong can turn a minor wound into a serious problem.
Wound Types
Wounds are classified by how they occur. Knowing the type tells you something about the contamination risk, healing trajectory, and care approach.
- Incision: Clean cut from a sharp edge — surgical incisions, knife lacerations with clean margins. Edges are well-defined and typically close well with sutures or staples. Low contamination if made under sterile conditions.
- Laceration: Irregular tear in the skin, often from blunt force or trauma. Edges may be ragged. Higher risk of contamination and more complex to close than incisions.
- Puncture: Small entry wound from a pointed object — nail, needle, bite. High infection risk because the depth is hard to assess and the wound tracks into tissue where anaerobic organisms can thrive. Animal and human bites are puncture wounds with very high contamination burden.
- Abrasion: Scraping of the superficial skin layers. Painful because nerve endings are exposed. Usually heals without closure but requires thorough cleaning to remove embedded debris.
- Avulsion: Forcible tearing away of skin and underlying tissue. Can involve partial or full thickness skin loss. Serious injury that may require grafting if significant tissue is missing.
Wounds can also be classified as acute (new, healing through normal phases) or chronic (stalled in one phase for more than 30 days, such as diabetic foot ulcers or pressure injuries).
Wound Healing Phases
Normal wound healing proceeds through three overlapping phases. Understanding these phases helps you recognize what a healing wound should look like — and when something is wrong.
Inflammatory Phase (Days 1-4)
Begins immediately after injury. Blood vessels dilate, increasing blood flow to the area. White blood cells migrate to the wound to fight bacteria and clear debris. The wound will be red, warm, swollen, and painful — this is normal inflammation, not infection. Serous or serosanguineous (pink-tinged) drainage is expected. Purulent (pus) drainage, increasing redness spreading from the wound edges, increasing pain after the first 48-72 hours, or fever suggests infection.
Proliferative Phase (Days 4-21)
New tissue forms. Fibroblasts lay down collagen, new capillaries grow into the wound (angiogenesis), and granulation tissue develops — the beefy red, granular-appearing tissue that fills the wound bed. Epithelial cells migrate across the surface from the wound edges inward. The wound visibly shrinks during this phase. Healthy granulation tissue is moist and red. Pale, grey, or black tissue in the wound bed signals a problem.
Maturation Phase (Day 21 — 2 years)
The wound is closed but not fully healed. Collagen is reorganized and cross-linked. The scar strengthens over time, eventually reaching about 80% of original skin tensile strength — skin never fully returns to pre-wound strength. The scar may initially be raised and red, gradually flattening and fading. Patients should protect healing wounds from sun exposure to minimize pigmentation changes.
Sterile Technique for Dressing Changes
Dressing changes on surgical wounds and any wound requiring sterile technique follow a consistent process. Before you begin, gather all supplies. Once you open a sterile field, your movements must be deliberate and controlled.
Preparation
- Review the order — type of dressing, any solutions ordered, frequency
- Perform hand hygiene
- Gather supplies: sterile dressing tray or individual sterile items, ordered wound care solution, tape, clean gloves, sterile gloves, waste bag
- Explain the procedure to the patient
- Position the patient for access to the wound
- Set up a clean work area
Removing the Old Dressing
- Apply clean gloves
- Loosen tape gently — pull toward the wound, not away from it, to reduce tension on healing tissue
- Remove the old dressing and assess: note amount, color, and odor of drainage; note wound appearance
- Dispose of old dressing in waste bag
- Remove clean gloves, perform hand hygiene
Setting Up the Sterile Field and Cleaning the Wound
- Open sterile supplies using aseptic technique — drop items onto the sterile field without reaching across it or contaminating it
- Pour any ordered solution carefully, without splashing
- Apply sterile gloves
- Clean the wound as ordered — typically from cleanest area to dirtiest (from center of wound outward, or from proximal to distal), using a single stroke per gauze piece
- Pat dry with sterile gauze
Applying the New Dressing
- Apply any ordered wound care products
- Cover with primary dressing, then secondary dressing as ordered
- Secure with tape, avoiding tension on the skin
- Remove sterile gloves, perform hand hygiene
- Make the patient comfortable, dispose of waste, clean the area
- Document
Suture and Staple Removal
Suture and staple removal is performed by the MA under a provider order. Timing depends on wound location and patient factors — generally 3-5 days for face, 7-10 days for scalp, trunk, and extremities, and up to 14 days for joints or areas under tension.
Suture Removal
Use suture removal kit (iris scissors and thumb forceps) or a dedicated suture removal kit. For each suture: grasp the knot with forceps, lift it slightly away from the skin, cut the suture below the knot on one side (so the suture pulled through the skin is the part that was outside, not the part that was inside), and pull through. Count sutures removed against sutures placed if documented. Clean the site. Apply steri-strips if the wound needs additional support.
Staple Removal
Use a staple remover. Position the lower jaw under the staple, squeeze the handle to bend the staple and lift it free. Count staples removed. Steri-strips may be applied for additional wound support after staple removal.
When to Stop and Call the Provider
Do not proceed with suture or staple removal if you observe: signs of infection (purulence, spreading erythema, increasing warmth, fever), wound dehiscence (separation of wound edges), or if the patient reports significant pain beyond what is expected. Apply a sterile dressing and notify the provider immediately.
When to Notify the Provider
During any wound care encounter, alert the provider if you observe:
- Purulent drainage (yellow, green, brown) or foul odor
- Increasing redness or warmth extending beyond the wound edges
- Wound dehiscence or evisceration
- Wound is not progressing as expected (no reduction in size, persistent slough)
- Patient reports increased pain since last assessment
- Signs of systemic infection: fever, chills, elevated heart rate
Documentation
Document wound care assessments and dressing changes thoroughly. Include:
- Date and time
- Wound location, dimensions (length x width x depth if measurable)
- Wound bed description (granulation, slough, eschar, epithelialization)
- Wound edges and surrounding skin
- Drainage: amount, color, consistency, odor
- Dressing removed and applied
- Solutions and products used
- Patient tolerance and any education provided
- Your name and credentials
Good wound documentation creates a record of healing progress and catches early deterioration. Photographs, when used, should follow your facility's policy for consent and storage.