Wounds

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A wound is a break in the continuity of tissues in the body. It may involve overlying epithelium like skin. Wounds are usually caused by injury. Tissues affected include subcutaneous tissue, muscles and even bones. It may be small or large and may be deep or superficial. It may bleed, may be contaminated with dirt and other foreign matter and become infected. 

Cause

  • Mechanical agents e.g. cut from cutlass or knife, gunshot, accidents, contusion from blunt injury. Wounds may follow snake or insect bites, animal or human bites
  • Chemical agents e.g. strong acids or alkalis, other corrosive chemicals
  • Thermal injury resulting in burns

Symptoms

  • Local pain
  • Bleeding
  • Discharge of pus if infected

Signs

  • Local swelling and tenderness
  • Look for other injuries e.g., head, chest, abdomen, bone, nerves
  • Determine the physical characteristics of the wound e.g. site, size, shape and depth

Investigations

  • Haemoglobin level if patient has bled
  • Group and cross-match blood if indicated
  • X-ray of injured part may be required to rule out osteomyelitis and bone fractures
  • Wound swab for culture and sensitivity if wound is infected

TreatmentTreatment Objectives

  • To control bleeding
  • To relieve pain 
  • To prevent or treat infection
  • To protect against tetanus
  • To promote wound healing 

Wound Management

  • Immediate closure of wounds is good, but this is not advisable if the wound is dirty or likely to become infected e.g. gunshot wounds, animal and human bites and wounds over 6 hours old. They should not be sewn up.
  • Wash hands well and wear sterile gloves. Clean the wound with antiseptic solution. Scrub dirty wounds with antiseptic solution and irrigate with dilute hydrogen peroxide and saline.
  • If there are bits of gravel, glass or dirt in the wound, remove them gently. Lift up all flaps of skin, clean under them, excise all dead tissue and cover the wound with sterile gauze.
  • Anaesthesia may be required.
  • Do not use Eusol, which is both irritant and exposes patient to unnecessary borate levels
  • Dress infected wound as often as needed with normal saline or povidone iodine lotion.
  • Take wound swab for culture and sensitivity test if possible and start Amoxicillin (Amoxycillin) while waiting for results of wound culture

Pharmacological treatment  1st Line Treatment

Evidence Rating: [C]

  • Tetanus prophylaxis for all potentially contaminated wounds, followed by booster doses of tetanus toxoid as appropriate (See section on 'Tetanus prophylaxis' 

And 

  • Amoxicillin (Amoxycillin), oral,

Adults

500 mg 8 hourly

Children 

6 -12 years; 250 mg 8 hourly 

1-5 years; 125 mg 8 hourly 

1 year; 62.5 mg 8 hourly 

Referral Criteria

Complicated wounds (e.g. wounds associated with fractures, division of tendons, blood vessels and nerves).