It may just start with a tiny cut or callus. But for people with conditions such as diabetes or peripheral vascular disease, that small opening in the skin can grow into a gaping wound that doesn’t heal.

That’s when wound care comes into play.

Wound care isn’t just about putting on some Neosporin and a bandage. Rather, it’s a sophisticated process to encourage skin that isn’t healing on its own to finally heal, said Megan Marion, an occupational therapist and wound care specialist with SportsMed at Yampa Valley Medical Center.

“It really affects quality of life,” she said about the impact of a chronic wound. “It is painful. It limits what a patient can do… and you’re at higher risk of infection.”

After an injury, the skin usually goes through four stages of healing: clotting, inflammation, new tissue formation and tissue maturation. In some cases, the healing stalls — usually in the inflammation stage — and won’t progress.

That’s where Marion’s work comes in. She begins by assessing a patient’s wound and overall health. She looks for certain medications that can delay healing and nutrition habits, including whether a patient is getting enough protein in his or her diet.

Next, Marion removes the dead tissue at the wound, a process called debridement. This step is critical. Without removing dead tissue, a wound cannot progress through healing.

For serious wounds, a surgeon may perform debridement while a patient is under anesthesia. Otherwise, Marion has various methods, including using sterile tweezers and scissors to gently remove the dead skin, or applying dressings and ointments that help the body break down the dead tissue on its own or through enzyme action. Medical-grade honey, for instance, lowers the pH level of a wound to promote healing.

Then, the skin must be rebuilt. Just as with a house, there’s no point in putting up a roof without a foundation.

“In our bodies, we have to build the new tissue up before the skin can close,” Marion said.

That means creating the right environment for skin to heal. That used to mean letting a wound dry out, but now, the focus is on moisture.

“The current science backing wound care is that a dry cell is a dead cell,” Marion said. “You actually want to provide moisture to the cut or the injury to promote healing.”

There’s still a balance: too much moisture and the tissue surrounding the wound can break down, creating a larger wound.

As the skin regenerates, Marion can apply various products. Some have collagen, which is a basic building block of skin and helps the body make new tissue faster, while others contain silver to lower the bacterial load.

At each appointment, Marion measures the wound’s depth, length and width. If it doesn’t progress after two weeks, she tries a different method.

“I always tell my patients a healthy wound should look like hamburger meat,” she said. “Healthy tissue is always red and beefy.”

Education is also key. Patients with diabetes are at the highest risk for amputation due to a chronic wound, so Marion encourages them to watch for and address even small blisters and scratches.

“Research shows if we can do prevention and treat a wound right when it shows up, then we can prevent amputation,” she said.

To prevent wounds, Marion recommends keeping skin moisturized and checking the feet for sores and cuts.

“The skin is the largest organ we have. It’s the first line of defense we have against the environment,” she said.

Which is a good reason to care for it well.

Susan Cunningham writes for Yampa Valley Medical Center. She can be reached at cunninghamsbc@gmail.com.