33. Wound treatment. Principles of wound treatment · General and Operative Surgery · MU Plovdiv

Wound Treatment

Written by Rhiana Devadasan

the process of stopping bleeding.
In most wounds, haemostasis is spontaneous
However during significant injury or laceration of vessels, steps may need to be taken to ↓ bleeding
Bleeding should be controlled usually with gentle, continuous pressure; elevation; tourniquets and suturing.

Effective local anesthesia before wound cleansing allows the physician to clean the wound thoroughly without causing pain.
Also pain relief will allow for easier & more humane closure of the wound.
Most commonly, local anaesthetic w/ regular systemic analgesia (paracetamol/ibuprofen) is given.

Most important step in reducing bacterial contamination and the potential for infection.

Disinfect skin around the wound w/ antiseptic (but avoid inside of the wound)
Explore & decontaminate wound by manually removing any foreign bodies (e.g. glass)
Debride any devitalised tissue where possible (but preserve tissue when possible, to avoid unnecessary tissue excision which can lead to a permanent uncorrectable & unsightly scar)
Irrigate wound with saline (if no obvious contamination present = low pressure irrigation is fine. If wound is clearly contaminated = must be irrigated at high pressure via a syringe to remove any visible debris present)
Antibiotics are advised for high-risk wounds or at any signs of infection (RFs: foreign body, heavily soiled wounds, bites, puncture wounds & open fractures)
4) Skin Closure

Using skin adhesive strips (for when no RFs for infection are present)
Using tissue adhesive glue (for small lacerations w/ easily opposable edges)
Sutures (for any laceration greater than 5cm, deep dermal wounds or in locations that are prone to flexion, tension or wetting. And because all sutures act as foreign bodies, as few deep sutures as possible are to be placed in any wound)
Staples (for some scalp wounds)
CLOSURE TENSION: when laceration edges are being brought together, they should just barely “touch”. Excessive wound constriction when suturing strangulates the tissue, leading to a poor outcome.
TISSUE HANDLING: rough handling of tissues, particularly when using forceps, can cause tissue necrosis and increase the chance of wound infection and scarring.

Correct dressing will reduce risk of infection & contamination.
First layer should be non-adherent (e.g. saline-soaked gauze), then should be followed by an absorbent material to attract any wound exudate, then finally tape must be applied to secure the dressing in place.