Wound Care (cont.)
- 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 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, poor circulation may be prescribed to prevent infection. Antibiotics may also be prescribed if underlying structures like tendons or bones are involved.
The prognosis for wound healing is individualized and depends upon the type of wound, the underlying injury, and the baseline health of the patient.
- Most minor wounds including simple lacerations and abrasions heal on their own and do not require medical care.
- The more complicated the patient and the more complicated the wound, the prognosis for a perfect outcome decreases. The goal for all wounds is to have healing that allows the return of the injured part to normal function.
- Outcome also depends upon the risk factors present. Wounds that are contaminated and very dirty are more likely to become infected, and heal poorly than those that are not. Wounds tend to heal with less success in individuals with poorly controlled diabetes or who have poor circulation.
- All lacerations will leave a scar but the health care practitioner will work to minimize the thickness and appearance of scars.
Accidents happen and most people will sustain a wound regardless of how careful they might be.
It is important to remember that when using tools at home or at work, to make certain they are being used in the appropriate manner and the appropriate precautions are taken. Often accidents occur because the person was in a rush, took a shortcut, or was using a tool in a way it wasn't designed.
Protective gear is always appropriate. Wearing proper shoes or boots, wearing a bike helmet, or eye protection regardless of the situation will prevent an injury.
Medically reviewed by a Board-Certified Family Practice Physician
Tintinalli J, etal. Tintinalli's Emergency Medicine: A Comprehensive Study Guide. 7th edition. McGraw-Hill Professional 2010.
Medically Reviewed by a Doctor on 3/2/2016
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