Open Wounds

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TREATMENT

NON-PHARMACOLOGICAL TREATMENT

  • Appropriately suture fresh wound (i.e., < 12 hours old)
  • Do not suture penetrating wound to chest or abdomen
  • Refer to the next level of care

Note:

  • Any skin damage overlying a fracture makes it an open fracture
  • It is important to ascertain the cause of the wound

PHARMACOLOGICAL TREATMENT

  • Always remember to give Tetanus Toxoid Vaccination 
  • If patient has signs of tetanus, give Tetanus Antitoxin Serum (ATS) 1,500 IU s/c or IM
  • If wound is grossly contaminated give Tetanus Antitoxin Serum 3,000 IU s/c or IM (alongside copious washing
  • Clean fresh wounds with large volumes of normal saline or sterile water.
  • High risk wounds may be irrigated with Cetrimide 15%+ Chlorhexidine Solution 1.5% (Savlon) diluted 1 in 20 parts water or diluted iodine.

Wound repair

  • For local infiltration or as a peripheral nerve block use Lignocaine Hydrochloride injection 1%, maximum dose: adults 4mg/kg body weight; children 3mg/kg (= 0.3ml/kg of 1%)
  • Or use Lignocaine 1% (10mg per 1ml) + adrenaline 1:200,000 injection around the wound, maximum dose: adults 7mg/kg, children 7mg/kg

Note: Do not use anaesthetics containing adrenaline for anaethesia in digits or appendages due to risk of ischaemic necrosis.