WOUNDS

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

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

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.)