Tuesday, April 20, 2021

Management of Cut and Lacerated open Wound (CLW)

Management of Cut and Lacerated open Wound (CLW)

• Rule out life threatening conditions and ensure that the patient is vitally stable

• Do a local X-Ray (if indicated/for suspected injury) to rule out stone, soil, etc

• Upon presentation, a laceration should be evaluated, and the bleeding controlled using direct pressure or even ligation of bleeding vessels/ spurters (under local anesthesia), if needed. If it's an oozing wound/ bleeding copiously, use H2O2 and compress

• Thorough cleaning to be done, no dirt/blood should be left in the wound. Copious wound irrigation with normal saline with a 50 ml syringe and 18-gauge needle (sometimes done directly by punching a hole into the saline bottle and pressing it) which washes away foreign matter and dilutes the bacterial concentration to decrease post-repair infection
• Any visible foreign matter should be removed with forceps, and devitalized tissue removed with sharp debridement with scalpel or dissecting scissors to reduce the risk of infection
• Local anesthesia with lidocaine 1% is given (especially if suturing is required)
• After anesthetising the wound, clean again, more vigorously (as the patient will be more compliant now)

• Foreign bodies near blood vessels, nerves, and joints should be removed with caution, and referral to seniors should be considered
• Local hair should be clipped, not shaved, to prevent wound contamination   
  1. For clean wound, small wound - suturing can be done:    
• Deep, multiple-layer wounds should be repaired using absorbable, simple interrupted sutures. Most other wounds can be closed effectively with non-absorbable, simple interrupted suture
• Absorbable sutures, such as Vicryl, Dexon and Monocryl are used to close deep, multiple-layer lacerations (Usually, 3-0 nylon (Ethilon) on cutting bodied needle is used)

• In general, a 1–0 or 2–0 suture is appropriate on the trunk, 3–0 or 4–0 on the extremities and scalp, and 4–0 or 5–0 on the face

• The horizontal mattress technique may be the best option for closing wounds on fragile skin because it spreads the tension along the wound edge

• The vertical mattress technique is good for closing high- tension wounds. It is also used to evert wound edges in areas that tend to invert, such as the posterior neck or concave skin surfaces

Place a latex drain in deep oozing wounds to prevent hematoma formation
        2. For clean contaminated wound or large wound where suturing is difficult:
• Perform wound debridement and wound toilet: 
I. Wound debridement - removing all dead and devitalised tissue from the wound
II. Wound toilet - Cleaning skin surrounding wound with antiseptic and irrigation of would with saline
These steps favor wound healing by secondary intention

• Continue the cycle of surgical debridement and saline irrigation until the wound is completely clean

• Pack wound lightly with damp saline gauze and cover the packed wound with a dry dressing
Change the packing and dressing daily or more often if the outer dressing becomes damp with blood or other body fluids.   

For suturing techniques and debridement, please refer to the respective documents. 

Written by our guest authors Omkar Doiphode and Tushar Mahajan

No comments:

Post a Comment

This is express yourself space. Where you type create something beautiful! <3
Wondering what do I write? Well...
Tell us something you know better. You are a brilliant mind. Yes, you are! ^__^
Ask about something you don't understand @_@?
Compliment... Say something nice! =D
Be a good critic and correct us if something went wrong :|
Go ahead. Comment all you like here! (:

PS: We have moderated comments to reduce spam. ALL comments that are not spam will be published on the website.