51. Wound management

Question 1

What are the 4 categories of wound management?

Answer 1

4 Categories:

1. Clean: Atraumatic, surgical wound, aseptic conditions
2. Clean contaminated: Minor break in asepsis e.g. Controlled entry into gastrointestinal tract
3. Contaminated: Recent wound with contamination with exposure to elements (abrasions) or major breaks In asepsis
4. Dirty or Infected: Old wound with exudate and obvious infection e.g. Wound with abscess

Question 2

10 steps for wound Management?

Answer 2

Wound management:
1. Triage and patient stabilisation:
» A; Airway, B: Breathing, C: Circulation
2. Control any obvious bleeding:
Pressure bandage or tourniquet (<1 hours)
3, Analgesia and antibiotics:
Systemic analgesia or local or regional analgesia
» Broad spectrum antibiotics
4. Prevention of further contamination:
Temporary sterile dressing: Moist gauze, cotton wool, elastoplast
5. Assessment for other Injuries:
> Radiographs (chest • contusions, spine) and ultrasound (free abdominal fluid)
6. Cleaning and preparing site for definitive management:
Clip surrounding hair, surgical scrub of surrounding skin (not wound)
7. Debridement:
Lavage with Hartmanns (best):
• 60ml syringe with 18g needle and 3 way tap
> Surgical removal of foreign material and necrotic /non-viable tissue:
Exploration of all wounds for dead space
• En-bloc debridement
Minimal debridement:
Distal limbs, bone and tendons aim to conserve as much as possible
8. Drainage:
> If excessive dead space that cannot be removed
> Drains exit from most dependent site
> Type:
Passive: Gravity
Active: Negative pressure
9, Promotion of wound granulation (If left open):
> Proper selection of bandaging material
10. Selection of an appropriate method of closure:
> Primary closure:
Clean, surgical wounds
• Infected wounds that can be removed en-bloc
> Delayed primary closure: 2 - 5 days post Injury
Contaminated wound with unsure viability
• Close when healthy granulation tissue has developed
• Bandage appropriately while waiting
> Secondary closure: > 5 days post Injury
Dirty or Infected wounds
Primary closure after granulation and epithelialisation:
Usually excision of granulation and epithelised tissue
Secondary Intention: Not closed primarily
• Large wounds that cannot be closed primarily
• Healing by contraction of wound over granulatlon tissue bed and epitheliallsatlon
Can be very time consuming and expensive
Not all wounds will heal properly

Question 3

Wound dressing and bandaging?

Answer 3