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. abscess
- Bites, e.g. insect, animal, human
- Missile and blast injury, e.g. gunshot, mines, exlosives, landmines
- Crush injury, e.g. RTA, building collapse
Clinical features
- Raw area of broken skin or mucous membrane
- Pain, swelling, bleeding, discharge
- Reduced use of affected part
- Cuts: sharp edges
- Lacerations: Irregular edges
- Abrasions: loss of surface skin
- Bruises: subcutaneous bleeding e.g. black eye
Management
Treatment
Minor cuts and bruises
- First aid, tetanus prophylaxis, dressing and pain management
- Antibiotics are not usually required but if the wound is grossly contaminated, give
- Cloxacillin or amoxicillin 500 mg every 6 hours as empiric treatment
- Child: 125-250 mg every 6 hours
- Cloxacillin or amoxicillin 500 mg every 6 hours as empiric treatment
Deep and/or extensive
- Identify the cause of the wound or injury if possible
- Wash affected part and wound with plenty of water or saline solution – (you can also clean with chlorhexidine 0.05% or hydrogen peroxide 6% diluted with equal amount of saline to 3% if wound is contaminated)
- Explore the wound under local anesthesia to ascertain the extent of the damage and remove foreign bodies
- Surgical toilet: carry out debridement to freshen the wound
- Tetanus prophylaxis, pain management, immobilization
If wound is clean and fresh (<8 hours)
- Carry out primary closure by suturing under local anaesthetic – Use lignocaine hydrochloride 2% (dilute to 1%
with equal volume of water for injection)
If wound is >8 hours old or dirty
- Clean thoroughly and dress daily
- Check the state of the wound for 2-3 days
- Carry out delayed primary closure if clean – Use this for wounds up to 2-4 days old
If wound >4 days old or deep pucture wound, contaminated wounds, bite/gunshot wounds, abscess cavity
- 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 gauzes
In case of extensive/deep wound
- Consider closure with skin graft/flap
Note:
- Use antibiotic prophylaxis in very contaminated wounds
- Use antibiotic treatment in infected wounds (wounds with local signs of infections e.g. cellulitis, lymphagitic streaking, purulence, malodor), – with or without systemic signs (fever, chills etc.)