WOUND MANAGEMENT Assessment

WOUND MANAGEMENT Assessment

Wound management is guided by the timing and mechanism of injury as well as factors a ff ecting healing ( Summary box 3.1 It is also important to assess the patient’s ideas, concerns and expectations. Patient outcomes also rely on good postoperative compliance. Assess the patient using Advanced Trauma Life Support principles to first identify and treat life- and then limb-threat ening conditions. Some wounds require a multidisciplinary approach; for example, the in volvement of orthopaedic sur geons and plastic surgeons in managing complex open lower 6 limb fractures. Assess the site, size, geometry and nature of any wounds. Look for signs of contamination, infection, swelling and pul satile bleeding. Deformities may suggest underlying fractures or dislocations. Has there been skin loss or degloving? What structures are visible? Thorough irrigation of wounds will allow better visualisa tion. It is important to correlate the clinical examination with the mechanism of injury as seemingly innocuous wounds can lead to underestimation of tissue damage. For exam ple, high-pressure injection injuries of the hand can cause of amputation. The injected substances can track proximally into the forearm. Urgent surgical exploration and debridement - is required. Before palpation, ensure that the patient has adequate anal - gesia or a local anaesthetic block. When possible, it is important to assess motor and sensory function before any local anaes - thesia. Unless there are obvious muscle injuries, the purpose of testing specific muscle groups is to evalua te potential nerve or tendon injuries. Imaging is useful to e xclude foreign bodies, fractures or dislocations where appropriate. WOUND MANAGEMENT Assessment

Wound management is guided by the timing and mechanism of injury as well as factors a ff ecting healing ( Summary box 3.1 It is also important to assess the patient’s ideas, concerns and expectations. Patient outcomes also rely on good postoperative compliance. Assess the patient using Advanced Trauma Life Support principles to first identify and treat life- and then limb-threat ening conditions. Some wounds require a multidisciplinary approach; for example, the in volvement of orthopaedic sur geons and plastic surgeons in managing complex open lower 6 limb fractures. Assess the site, size, geometry and nature of any wounds. Look for signs of contamination, infection, swelling and pul satile bleeding. Deformities may suggest underlying fractures or dislocations. Has there been skin loss or degloving? What structures are visible? Thorough irrigation of wounds will allow better visualisa tion. It is important to correlate the clinical examination with the mechanism of injury as seemingly innocuous wounds can lead to underestimation of tissue damage. For exam ple, high-pressure injection injuries of the hand can cause of amputation. The injected substances can track proximally into the forearm. Urgent surgical exploration and debridement - is required. Before palpation, ensure that the patient has adequate anal - gesia or a local anaesthetic block. When possible, it is important to assess motor and sensory function before any local anaes - thesia. Unless there are obvious muscle injuries, the purpose of testing specific muscle groups is to evalua te potential nerve or tendon injuries. Imaging is useful to e xclude foreign bodies, fractures or dislocations where appropriate. WOUND MANAGEMENT Assessment

Wound management is guided by the timing and mechanism of injury as well as factors a ff ecting healing ( Summary box 3.1 It is also important to assess the patient’s ideas, concerns and expectations. Patient outcomes also rely on good postoperative compliance. Assess the patient using Advanced Trauma Life Support principles to first identify and treat life- and then limb-threat ening conditions. Some wounds require a multidisciplinary approach; for example, the in volvement of orthopaedic sur geons and plastic surgeons in managing complex open lower 6 limb fractures. Assess the site, size, geometry and nature of any wounds. Look for signs of contamination, infection, swelling and pul satile bleeding. Deformities may suggest underlying fractures or dislocations. Has there been skin loss or degloving? What structures are visible? Thorough irrigation of wounds will allow better visualisa tion. It is important to correlate the clinical examination with the mechanism of injury as seemingly innocuous wounds can lead to underestimation of tissue damage. For exam ple, high-pressure injection injuries of the hand can cause of amputation. The injected substances can track proximally into the forearm. Urgent surgical exploration and debridement - is required. Before palpation, ensure that the patient has adequate anal - gesia or a local anaesthetic block. When possible, it is important to assess motor and sensory function before any local anaes - thesia. Unless there are obvious muscle injuries, the purpose of testing specific muscle groups is to evalua te potential nerve or tendon injuries. Imaging is useful to e xclude foreign bodies, fractures or dislocations where appropriate.