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Wound Management
Evaluation
Before wound treatment is performed, a full evaluation of the wound must be undertaken.
Acute Wounds
1. Assess size, shape, and location
2. Determine the timing of the wound – acute (time elapsed since injury) versus chronic (persistent >3 months)
3. Establish laceration, avulsion, or chronic open wound
4. Evaluate the wound for odor, exudate, purulent drainage, bleeding, and debris
5. Determine if there is exposure of vessels, tendons, nerves, joint, muscle, or bone
6. Evaluate for foreign bodies in the wound: consider X-ray evaluation—if the history is inconsistent with clinical evaluation.
Chronic Wounds
Chronic wounds require investigation into reasons why proper wound healing is not accomplished.
Intrinsic Inhibitions of Wound Healing | Exogenous Inhibitions of Wound Healing |
Poor blood supply Infection Bacterial contamination >105 or 104 group B streptoccocus species Wound tension or pressure >30 mmHg | Advanced age Malignancy Poor nutrition History of radiation Severe symptoms of disease (e.g., diabetes) Immunosuppression Smoking |
Therefore, chronic contamination wounds warrant serologic evaluation to include
WBC
Hct/HbB
Albumin
Pre albumin, B transferin
ESR/SED
Treatment
Acute Wounds
Irrigation in the acute wound setting is designed to remove blood, foreign bodies, debris, and bacteria from a wound. This can easily be accomplished with a 1-L bottle of normal saline with two or three holes punched into the cap with an 18-gauge needle. When squeezed forcefully, it serves as an effective pressurized irrigator. The wound should be irrigated until all visible debris is washed away. Anesthetizing the wound prior to irrigation and débridement provides for greater patient comfort and allows for aggressive decontamination of the wound.
Chronic Wounds
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