Management Of Different Types Of Wounds

Management Of Different Types Of Wounds

• Wound is inspected and classified as per the type of wounds.
• If wound is in the vital area, then:
• The airway should be maintained.
• The bleeding, if present, should be controlled.
• Intravenous flids are started.
• Oxygen, if required, may be given.
• Deeper communicating injuries and fractures, etc.should be looked for.
• If it is an incised wound, then primary suturing is done after thorough cleaning.
• If it is a lacerated wound, then the wound is excised and primary suturing is done.
• If it is a crushed or devitalized wound there will be edema and tension in the wound.
  • So after wound debridement or wound excision by excising all devitalized tissue, the edema is allowed to subside for 2—6 days.
  • Then delayed primary suturing is done.
• If it is a deep devitalized wound, after wound debridement it is allowed to granulate completely.
  • Later, if the wound is small secondary suturing is done.
  • If the wound is large a split skin graft (Thiersch graft) is used to cover the defect.
• In a wound with tension, fasciotomy is done so as to prevent the development of compartment syndrome.
• Vascular or nerve injuries are dealt with accordingly.
  • Vessels are sutured with 6-zero polypropylene nonabsorbable suture material.
  • If the nerves are having clean, cut wounds it can be sutured primarily with polypropylene 6-zero or 7-zero suture material. If there is diffilty in identifying the nerve ends or if there are crushed cut ends of nerves then marker stitches are placed using silk at the site and later secondary repair of the nerve is done.
• Internal injuries (intracranial by craniotomy, intrathoracic by intercostal tube drainage, intra-abdominal by laparotomy) has to be dealt with accordingly.
  • Fractured bone is also identifid and properly dealt with.
• Antibiotics, flid and electrolyte balance, blood transfusion, tetanus toxoid (0.5 mL intramuscular to deltoid muscle), or antitetanus globulin (ATG) injection.
• Later defiitive management is done with: Wound debridement (wound toilet, or wound excision) is liberal excision of all devitalized tissue at regular intervals (of 48–72 hours) until healthy, bleeding, vascular tidy wound is created.