Wound Management Flashcards
Basic principles wound management
Haemostasis
Cleaning the wound
Analgesia
Skin closure
Dressing and follow-up advice
Haemostasis
In most wounds, haemostasis will be spontaneous.
In cases of significant injury or laceration of vessels, steps may need to be taken to reduce bleeding and aid haemostasis. These include pressure, elevation, tourniquet, or suturing.
Wound cleaning
Wound cleaning is important for reducing infection and promoting healing. There are five aspects of wound cleaning:
Disinfect the skin around the wound with antiseptic
Avoid getting alcohol or detergents inside the wound
Decontaminate the wound by manually removing any foreign bodies
Debride any devitalised tissue where possible
Irrigate the wound with saline
If there is no obvious contamination present, low pressure irrigation is sufficient. If the wound is clearly contaminated, it must be irrigated at high pressure to remove any visible debris present
Antibiotics for high-risk wounds or signs of infection (follow local antibiotic guidelines)
Risk factors for wound infection
Foreign body present or heavily soiled wounds, bites (including human), puncture wounds, and open fractures
Lidocaine doses
Lidocaine (Lignocaine)
Without adrenaline: 3 mg/kg (max 200 mg)
With adrenaline: 7 mg/kg (max 500 mg)
Prilocaine
Without adrenaline: 6 mg/kg (max 400 mg)
With adrenaline: 8 mg/kg (max 600 mg)
Levobupivacaine (safer enantiomer of bupivacaine)
Without adrenaline: 2 mg/kg (max 150 mg)
With adrenaline: 3 mg/kg (max 225 mg)
Skin closure
The aid wound healing, the edges of the wound can be manually opposed. There are four main methods of doing so:
Skin adhesive strips (e.g. Steri-StripsTM) are suitable if no risk factors for infection are present
Tissue adhesive glue (e.g. Indermil®) can be used for small lacerations with easily opposable edges (a popular choice in paediatrics)
Sutures are typically used for any laceration greater than 5cm, deep dermal wounds, or in locations that are prone to flexion, tension, or wetting
Staples can be used for some scalp wounds
Sutures by absorbability
Absorbable Sutures (dissolve naturally in the body)
Uses: Internal tissues, muscles, and organs.
Examples:
Vicryl (Polyglactin 910): General soft tissue, skin closure in children.
Monocryl (Poliglecaprone 25): Subcutaneous tissues and skin closure.
PDS (Polydioxanone): Long-term support for fascia or tendons.
Benefits: No need for removal, reducing patient discomfort.
Non-Absorbable Sutures (require removal unless used internally)
Uses: Skin, tendons, and cardiovascular or orthopedic surgeries.
Examples:
Silk: Mucosal surfaces (e.g., oral cavity).
Prolene (Polypropylene): Vascular and skin suturing.
Nylon (Ethilon): Skin closure, minimal tissue reactivity.
Benefits: Greater tensile strength, ideal for long-term support.
Sutures by structure
Monofilament (single strand)
Uses: Skin closure, vascular surgery.
Examples: Prolene, Monocryl, PDS.
Benefits: Less tissue trauma and infection risk but more prone to knot slippage.
Multifilament (Braided) (multiple fibers twisted or braided)
Uses: Internal tissues and ligaments.
Examples: Vicryl, Silk.
Benefits: Better knot security but may harbor bacteria.
Sutures by material
Natural Sutures: Silk, Catgut (absorbable, from bovine or sheep intestines).
Synthetic Sutures: Prolene, Vicryl, Monocryl, PDS—more predictable absorption and less reactivity.
Specialised sutures
Barbed Sutures: No knots required, used in cosmetic surgery.
Antimicrobial Sutures: Coated with triclosan to reduce infection risk.
Dressing wounds and follow up
Correct dressing of the wound will reduce infection and contamination.
When applying a wound dressing to a non-infected laceration, the first layer should be non-adherent (such as a saline-soaked gauze), followed by an absorbent material to attract any wound exudate, and finally soft gauze tape to secure the dressing in place.
Tetanus prophylaxis is required for any individual not up to date with (or unsure of) their tetanus immunisation status.
Following initial wound management, advise patients to:
Seek medical attention for any signs of infection
Take simple analgesia (e.g. paracetamol)
Keep the wound dry as much as possible, even if wearing a waterproof dressing
Any sutures or adhesive strips should be removed 10-14 days after initial would closure (or 3-5 days if on the head); tissue adhesive glue will naturally slough off after 1-2 weeks.
Remove dressings at the same time as the sutures or adhesive strips.
