Principles

Principles

Clinical judgement is crucial in managing wounds. Some general principles of wound management are summarised in Table 3.2 . Antibiotic prophylaxis is needed for clean–contam - inated, contaminated and dirty wounds. It may also be used in clean wounds when there is a high risk of infection or when the sequelae of infection are potentially disastrous. Tetanus prophylaxis should be given based on the type of wound ( T able 3.3 ) and immunisation status ( Figure 3.6 ). ). - /uni25CF - /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF - Debridement is essential to remove any devitalised tissue and foreign material from the wound. Non-viable tissue - must be excised until healthy bleeding occurs at the wound edges. The importance of thorough debridement is often

TABLE 3.2 Principles of wound management. Preparation Antibiotic prophylaxis Tetanus prophylaxis Adequate analgesia/anaesthesia Wound irrigation Wound Early debridement and irrigation Exploration Repair structures Haemostasis Closure Skin closure without tension Consider reconstruction options Suture choice Consider drains Optimal dressings Follow-up Removal of sutures/splints Physiotherapy Monitoring for complications Scar management 7 TABLE 3.3 Tetanus-prone wounds. Tetanus-prone wounds High-risk tetanus-prone wounds Any tetanus-prone wound with: Puncture-type injuries in a contaminated environment Heavy contamination, e.g. soil or manure Bites Compound fractures Wound requiring surgery with >6-hour delay Containing foreign bodies Wounds or burns with Extensive devitalised tissue systemic sepsis Adapted from https://www.gov.uk/government/publications/tetanus

prone-wounds-posters.

Principles

Clinical judgement is crucial in managing wounds. Some general principles of wound management are summarised in Table 3.2 . Antibiotic prophylaxis is needed for clean–contam - inated, contaminated and dirty wounds. It may also be used in clean wounds when there is a high risk of infection or when the sequelae of infection are potentially disastrous. Tetanus prophylaxis should be given based on the type of wound ( T able 3.3 ) and immunisation status ( Figure 3.6 ). ). - /uni25CF - /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF - Debridement is essential to remove any devitalised tissue and foreign material from the wound. Non-viable tissue - must be excised until healthy bleeding occurs at the wound edges. The importance of thorough debridement is often

TABLE 3.2 Principles of wound management. Preparation Antibiotic prophylaxis Tetanus prophylaxis Adequate analgesia/anaesthesia Wound irrigation Wound Early debridement and irrigation Exploration Repair structures Haemostasis Closure Skin closure without tension Consider reconstruction options Suture choice Consider drains Optimal dressings Follow-up Removal of sutures/splints Physiotherapy Monitoring for complications Scar management 7 TABLE 3.3 Tetanus-prone wounds. Tetanus-prone wounds High-risk tetanus-prone wounds Any tetanus-prone wound with: Puncture-type injuries in a contaminated environment Heavy contamination, e.g. soil or manure Bites Compound fractures Wound requiring surgery with >6-hour delay Containing foreign bodies Wounds or burns with Extensive devitalised tissue systemic sepsis Adapted from https://www.gov.uk/government/publications/tetanus

prone-wounds-posters.

Principles

Clinical judgement is crucial in managing wounds. Some general principles of wound management are summarised in Table 3.2 . Antibiotic prophylaxis is needed for clean–contam - inated, contaminated and dirty wounds. It may also be used in clean wounds when there is a high risk of infection or when the sequelae of infection are potentially disastrous. Tetanus prophylaxis should be given based on the type of wound ( T able 3.3 ) and immunisation status ( Figure 3.6 ). ). - /uni25CF - /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF /uni25CF - Debridement is essential to remove any devitalised tissue and foreign material from the wound. Non-viable tissue - must be excised until healthy bleeding occurs at the wound edges. The importance of thorough debridement is often

TABLE 3.2 Principles of wound management. Preparation Antibiotic prophylaxis Tetanus prophylaxis Adequate analgesia/anaesthesia Wound irrigation Wound Early debridement and irrigation Exploration Repair structures Haemostasis Closure Skin closure without tension Consider reconstruction options Suture choice Consider drains Optimal dressings Follow-up Removal of sutures/splints Physiotherapy Monitoring for complications Scar management 7 TABLE 3.3 Tetanus-prone wounds. Tetanus-prone wounds High-risk tetanus-prone wounds Any tetanus-prone wound with: Puncture-type injuries in a contaminated environment Heavy contamination, e.g. soil or manure Bites Compound fractures Wound requiring surgery with >6-hour delay Containing foreign bodies Wounds or burns with Extensive devitalised tissue systemic sepsis Adapted from https://www.gov.uk/government/publications/tetanus

prone-wounds-posters.