Wound Care (cont.)
Wound Medical Care
- The health care practitioner will make certain that there is no associated injury with the
wound (for example, if a person falls on their chin, they may be at risk for a
jaw fracture), and that the risk of infection is minimized. Good cosmetic appearance with
a thin scar is also a goal, but it is not necessarily the most important goal.
- History is important to understand the
circumstances of the injury, because mechanism of injury will significantly
affect the care provided. An animal bite will require more medical care than one
cause by a fall on the playground.
- It is important to know the circumstances of the injury to decide how dirty
the wound might be, and whether there are any potential underlying injuries.
- Individuals with diabetes, poor
circulation, on dialysis, or taking medications that can compromise the immune
system are at higher risk of infection; and the decision to repair a wound may be
affected by the patient's medical history.
- Tetanus immunization status will be required to
determine if immunization is required.
- The time frame from when the initial injury occurred, and when medical
care is sought is also a consideration. The longer a wound is left open, the
higher the risk of infection if it is sutured. The guide for many health care
practitioners is between 6 and
12 hours. If the wound is older than 6 to 12 hours, it may not be sutured.
- Lacerations of the extremities including legs, arms, feet and hands may
involve tendons, nerves and arteries. Assessing their function is an important
part of the physical examination.
Sutures (Stitches) for Wounds
Primary closure: The health care practitioner will clean the wound and
then explore the area for foreign bodies or underlying structures that may have
been damaged prior to closing the wound with sutures, staples, or surgical glue.
If the wound is too
old, too dirty, or if there are other reasons to believe that closing the wound
is inappropriate, healing may occur by secondary intention. The wound
will be cleaned, dressed, and allowed to heal gradually over
time without sutures.
In otherwise healthy people with potentially dirty
wounds, a combination of the two techniques may be considered (secondary
intention and then primary closure). In this scenario, the health care
practitioner will clean and dress the wound. The patient will be asked to return
within 3-5 days, and if the wound shows no evidence of infection, it may be
closed with sutures, staples, or surgical glue.
Other Wound Dressings
Physiologic dressings such as Tegaderm or Hydrogel may be used to
promote healing instead of suturing in the elderly due to their very fragile
skin, which makes it difficult to repair lacerations and tears in the skin.
Antibiotics for Wounds
If a wound is cleaned and cared for properly, there is often little need to prescribe antibiotics.
However, animal bites, human bites,
wounds exposed to river or lake
water contamination, or other significantly dirty wounds, antibiotics may be
prescribed to prevent infection. Antibiotics may also be prescribed if underlying structures like tendons
or bones are involved.
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