1 of 21

MANAGEMENT OF TRAUMATIC WOUNDS

Wound Care Training Module

Wound Care Training Module - National Wound Care Committee

Wound Care Training Module

Wound Care Training Module - National Wound Care Committee

2 of 21

  1. Clinical Assessment
  2. Treatment
  3. Precautions
  4. Adjuncts

​

Content

Wound Care Training Module - National Wound Care Committee

Content

Wound Care Training Module - National Wound Care Committee

3 of 21

CLINICAL ASSESSMENT

History

  • Main Points:
    • Time elapsed since injury
    • Mechanism of injury
    • Cleanliness of wound and possibility of retained foreign body
    • AMPLE (Allergy, Medication, Past History, Last Meal, Environment)

​

​

Wound Care Training Module - National Wound Care Committee

4 of 21

Examination

  • Inspection
    • Anatomical location and possibility of associated more serious injuries (especially neck, chest, abdomen)
    • Size wound edge and tissue loss
    • Cleanliness
    • Viability

​

​

  • Palpation
    • Crepitus or foreign bodies
    • Neurovascular status
    • Tendons and movement

​

Wound Care Training Module - National Wound Care Committee

5 of 21

​

Investigations

​

  • X-ray if indicated for possible foreign bodies or suspected bone fracture

​

​

​

Wound Care Training Module - National Wound Care Committee

6 of 21

TREATMENT

Principles

  • Treat life or limb threatening conditions first. 
  • Initial management of the patient is as per ATLS principles. 
  • Wounds which are bleeding torrentially and/or will lead to circulatory distress are included under the ATLS principles. All other wounds will be treated expectantly after settling primary survey conditions.

​

Wound Care Training Module - National Wound Care Committee

7 of 21

Management of Bleeding Wounds in Primary Survey

  1. Stop bleeding in the fastest and simplest manner first rather than closure of the wound especially if other life threatening conditions are present.

​

Bleeding wound post trauma

Wound Care Training Module - National Wound Care Committee

8 of 21

  1. Options to stop bleeding include:

​

  • Direct pressure compression
    • Haemostatic sutures
    • Tourniquet for special situations (controversial and to be applied with a specialist consult)
    • Artery forceps especially for scalp wounds or laceration involving major vessels e.g. limb vessels.
    • Haemostatic materials if available (expensive)

​

Wound Care Training Module - National Wound Care Committee

9 of 21

TREATMENT

Local or General Anaesthesia

  • Dependent upon site and size of wounds, allergic constraints, patient factors e.g. age or patient’s preference.

​

Toilet and debridement

  • Thorough irrigation with normal saline (refer respective chapter: cleansing solution)
  • Remove foreign materials and dirt
  • Debride unhealthy tissue

​

Wound Care Training Module - National Wound Care Committee

10 of 21

Primary closure

  • Aim for this in all cases if possible Tension free closure
  • Possible methods include:
    • Suture
    • Skin adhesive strip
    • Skin glue

​

Surgical wound closure with suture

Wound Care Training Module - National Wound Care Committee

11 of 21

Delayed Primary Closure

  • Definition: closure of the wound after 72-hour
  • Usually for the following conditions:
    • Minimal tissue loss
    • Dirty wounds e.g. bites, contaminated environment
    • More than 12 hours from time of injury

​

Wound Care Training Module - National Wound Care Committee

12 of 21

Secondary healing

  • When there is extensive tissue loss with inability to oppose wound edges and allow healing by granulation.

​

Dressings

  • Any barrier dressing available that does not stick to the wound and has some adsorbent properties (refer to chapter on dressing materials).

​

Wound Care Training Module - National Wound Care Committee

13 of 21

Advice on discharge

  • Keep wound dry, shower allowed after 48 hours but avoid soaking wounds.
  • Avoid getting wound dirty.
  • Avoid exposure to direct sunlight especially for facial wounds.
  • Dressing may be removed after 48 hours.
  • Seek medical help if wound is foul smelling, there is extreme pain or extensive discharge.
  • Date for removal of sutures if used. Otherwise can allow glue and skin adhesive strip to drop off by itself or after wound healed visually.

​

Wound Care Training Module - National Wound Care Committee

14 of 21

PRECAUTIONS

  • Special Situations Which May Need Specialist Consult / referral
    • Facial wounds especially to eyelid, ear, Vermillion border of lip
    • Suspected nerve or tendon injury
    • Deep wounds in areas e.g. neck, chest, abdomen
    • Joints Electrical or severe crush injuries

Crush injury of the leg following motor vehicle accident

Wound Care Training Module - National Wound Care Committee

15 of 21

  • Cases which need close follow up after primary closure
    • Infection prone area e.g. perineum
    • Degloving injuries where viability may be suspect
    • Pedicled wounds where viability may be suspect especially with narrow base
    • Patients with significant co-morbid e.g. Diabetes, immunocompromised conditions, malnourished, on medications which may impair healing e.g. steroids, chemotherapy
    • Wound infected after primary closure should be opened up, drained and dressed and let it heal by secondary intention. Antibiotic might be considered.

Wound Care Training Module - National Wound Care Committee

16 of 21

ADJUNCTS

  • Antibiotics: In the wound context generally not needed, except for a possible single prophylactic dose before primary closure. No substitute for surgery. Exceptions where empirical antibiotics may be needed include:
    • Communication with bone fractures or joint space
    • Areas with difficulty in adequate debridment e.g. near tendons and fascial spaces of hands
    • Delayed treatment >6 hours
    • Involving entry into a hollow viscus organ esp GIT
    • Immunocompromised patients
    • Clostridial prone wounds soil contamination wound

​

​

Wound Care Training Module - National Wound Care Committee

17 of 21

ADJUNCTS

  • Choice of antibiotic 🡪 refer National Antibiotic Guidelines
  • Antitetanus: according to local protocol
  • Splints : for immobilisation in special situations
  • Colostomy for certain perineal wounds
  • Continous bladder drainage when indicated

​

Wound Care Training Module - National Wound Care Committee

18 of 21

Algorithm for management of traumatic wound

Wound Care Training Module - National Wound Care Committee

19 of 21

TAKE HOME MESSAGES

  • All traumatic wounds have risk of infection.

Wound Care Training Module - National Wound Care Committee

20 of 21

REFERENCES

  • Adam J. Singer, M.D., Judd E. Hollander, M.D., and James V. Quinn, M.D. N Engl J Med 1997; 337:1142-1148October 16, 1997DOI: 10.1056/NEJM199710163371607 Evaluation and Management of Traumatic Lacerations

Wound Care Training Module - National Wound Care Committee

21 of 21

THANK YOU

Wound Care Training Module - National Wound Care Committee