Wounds

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• Any break in the continuity of the skin or mucosa or disruption in the integrity of tissue due to injury

Causes

• Sharp objects, e.g. knife, causing cuts, punctures
• Blunt objects causing bruises, abrasions, lacerations
• Infections, e.g. abscesses
• Bites, e.g. insect, animal, human
• Missile and blast injury, e.g. gunshot, mines, explosives, landmines
• Crush injury, e.g. road traffic accidents, building collapse

Signs and symptoms

• Pain, fever, Redness, bleeding
• Inflammation
• Lacerations
• Abrasions
• Bruises with intact skin
• Loss of function and movement

Investigations

• Full blood count
• Blood glucose

Treatment Objectives

• Prevent infection
• Prevent profuse bleeding
• Relieve pain and fever
• Promote healing

Non-pharmacological Treatment

• Stop
• Apply manual pressure.
• Raise the bleeding site above the level of the heart..
• Remove all dirt and foreign bodies from the wound.
• Wash affected part of wound with plenty of water or saline solution (you can also clean with chlorhexidine 0.5%, povidone iodine 10% or hydrogen peroxide 6% diluted with equal amount of saline to 3% if wound is contaminated)
• Suture larger and deeper wounds using anaesthetic

Pharmacological Treatment

Minor cuts and bruises

• Apply first aid treatment
• Give tetanus toxoid if patient has never been immunized or if last dose was >5 years ago
• Antibiotics are not usually required but if the wound is grossly contaminated, give

Amoxicillin oral

Adult:

500 mg every 6 hours for 7 days as empiric treatment

Child:

125-250 mg every 6 hours for 7 days

OR In penicillin-allergic patients give

Erythromycin oral

Adult:   

500 mg every 6-8 hr (maximum 4 g/day) for 7 days

 Child:

60-100 mg/kg/day every 6-8 hrs (maximum 4g/day) for 7 days

Relieve pain with

Paracetamol oral  

Adult:     

1 g 3-4 times a day when required

Child:      

125-500 mg every 6 hours when required

Deep and/or extensive wounds

Follow first aid treatment and procedures for minor wound care above

• Carry out debridement to freshen the wound

If wound is clean and fresh (<8 hours)

• Follow first aid treatment above and procedures for minor wound
• Carry out primary closure by suturing under local anaesthetic
• Use 2% lignocaine hydrochloride (dilute to 1% with equal volume of water for injection)

If wound is >8 hours old or dirty

• Clean thoroughly as described above and dress daily
• Check the state of the wound for 2-3 days

If wound >4 days old or deep puncture wound, contaminated wounds, bite/gunshot wounds, abscess cavity

• Follow first aid treatment above and procedures for wound above
• Let it heal by secondary closure (granulation tissue)
• Dress daily if contaminated/dirty, every other day if clean
• Pack cavities (e.g. abscesses) with saline-soaked gauze

Note:

• Use antibiotic prophylaxis only in very contaminated wounds
• Use antibiotic treatment in infected wounds (wounds with local signs of infections e.g. cellulitis, lymphangitis; streaking, purulence, malodour) – with or without systemic signs (fever, chills etc.)

For wound with odour:

Cloxacillin oral

25–50 mg/kg orally four times a day for 5-7days

Note: To treat possible S. aureus infection (for most wounds)

OR

Ampicillin oral

25–50 mg/kg orally four times a day for 5-7 days

PLUS

Gentamicin IM or IV

7.5 mg/kg IM or IV once a day

PLUS

Metronidazole oral

7.5 mg/kg three times a day for 5-7 days

Note: Use regimen if bowel flora are suspected.

Referral

Refer all complicated wounds for specialist care