Wound or type of physical injury where in the skin is torn, cut or punctured. Though minor injuries can heal with conservative management, it poses risk of localised or systemic infection in patients who are at high risk (diabetics, obese, immunocompromised and elderly).
Medications:
- Inj. Tetanus toxoid – 0.5 ml i.m. if patient hasn’t received it over the last 10 years.
- Tab. Dolo 650 (Paracetamol 650 mg) 1 tablet 4 times per day.
- Cap. Mox 500 (Amoxicillin 500 mg) 1 capsule every 8 hours for 7 days.
- I.V. fluids and blood transfusion as required.
Wound management:
- Apply sterile pressure dressing to bleeding site and raise the injured part to control bleeding. A tourniquet may be applied if bleeding is profuse and cannot be controlled by pressure. Consider ligation of bleeding vessel if possible.
- Bleeding from a tooth socket – put a small piece of sterile gauze in the socket and ask the patient to bite on it.
- Immediate closure of wound is advisable unless is dirty or likely to become infected.
- Clean the wound, fibrin tissue, haematoma and necrotic material using normal saline or Oxum spray but preserve granulation tissue.
- Avoid antiseptics like Povidone Iodine, Hydrogen peroxide.
- Topical anesthetic Nummit Topical (Lidocaine 15% w/w spray) – applied 5 to 10 minutes before debridement. Deeper involvement will require local anesthetic (e.g. Lidocaine 1% injection).
- Do not debride stable healing wound with dry eschar.
Wet to moist dressing
- First layer – wet 4 x 4 gauze with saline or Oxum spray
- Second layer – Apply Bactigras gauze (Chlorhexidine acetate 0.5%).
- Third layer – apply dry 4 x 4 gauze.
- Fasten gauze roll bandage to hold it in place.
- Change the type and time of dressing according to the wound and amount of exudate.
Investigations:
- CBC, ESR – to evaluate the extent of systemic infection.
- Group and cross match blood if indicated.
- X ray of injured part may be required to rule out fracture or osteomyelitis.
- Wound swab for culture and antibiotic sensitivity if wound is infected.
Referral:
For non healing wounds refer to general surgeon. Consider referral to orthopedic surgeon if there is evidence of bone involvement.