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Wound management
This document provides guidance on wound management and closure techniques in the emergency department. It discusses assessing wounds, types of closure like sutures, staples and glue. Suture techniques like simple interrupted and mattress styles are covered. Finally, it reviews wound dressings and their appropriate uses for situations like burns, bleeding, or to promote healing. The goal is to close wounds effectively while preventing infection and promoting good cosmetic and functional recovery.
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Wound management
- 1. Wound Management in theED James Pocock
- 2. Topics for thisSession Assessment of Wounds in ED Types of Wound Closure Sutures Suture Techniques Staples Steristrips Adhesive Glue Wound Dressing
- 3. Lacerations and Woundsin the ED Common Most common in young men Sites Head & Neck- 50% Upper limbs- 35% 1.1-12% risk of infection in all wounds presenting to ED
- 4. Lacerations and Woundsin the ED Concerns for Patient Functional outcome Cosmesis Least painful repair Avoiding infection
- 5. Initial Assessment ofWounds in ED Stabilisation History Host factors Allergies Tetanus Time since injury ‘Golden Period’ Examination Distal neurovascular status Functional status of surrounding structures Foreign Bodies
- 7. ED Management Anaesthesia Local Topical Regional Irrigation ~100ml per 1cm Debridement
- 8.
- 9. Staples Fast Lowwound reactivity Low rates of infection Use on scalp, trunk Avoid in areas where cosmesis is important
- 10. Tissue Adhesive Glue Simple lacerations with minimal tension <3cm in length Fast Less painful than sutures Needs to be dry skin Hold wound for 30s Comparable to 5-0 suture
- 11. Steri-Strips Least reactiveof all wound closure methods Need clean wound Oppose slightly separated wound edges Minimal tensile strength Placed perpendicularly across the wound 2-4mm between each strip Must be kept dry and
- 12. Sutures Variety ofmaterials, sizes available Absorbable leads to increased reactivity Natural fibres more reactive than synthetic Avoid silk in ED Monofilament vs multifilament Absorbable suture uses: Deep dermal- degrade in ~60 days Mucosal Unlikely to seek follow up Suture size should be smallest to resist the wound’s tension
- 14. Suture Sizes byRegion
- 15.
- 16. Delayed Primary Closure Uses Heavily contaminated wounds Delayed presentation Concerns about infection Decreases infection rate by ~50% Technique Clean & Debride Fine mesh dressing Large gauze dressing Review in 3-4 days
- 17.
- 19. Suture Types atSCGH Surgipro Synthetic Unbraided Sizes from 3-0 to 6-0 Most commonly used suture at SCGH
- 20. Suture Types atSCGH Vicryl Rapide Synthetic Braided Sizes 4-0 & 5-0 in ED Uses: Mucosal injuries Deep dermal sutures If patient is unlikely to engage in follow up
- 21. Suture Types atSCGH Cat Gut 6-0 Absorbable, natural Used for nail bed lacerations Braided Silk Securing CVC, ICDs, etc Not used for wound closure
- 22.
- 23. Suture Techniques Simpleinterrupted
- 24. Suture Techniques DeepDermal Suture
- 25. Suture Techniques VerticalMattress Useful in areas of high tension (e.g. shin) Can lead to ischaemia around wound edges
- 26.
- 27. Dressings at SCGH Large number of dressings available in ED When working out what dressing, think about intention
- 28.
- 29. Burns Management Acticoat Silver coated Prevent infection Uses: Burns Needs activation with sterile water
- 30. Wound Management Intrasite Hydrogel-impregnated Uses: Slow healing/ necrotic wounds Lifts aware slough, necrotic tissue and eschar Allows granulation tissue to form Burns
- 31. Active Bleeding Majorbleeds Consider direct or indirect pressure ?Tourniquet Ligature of the vessel if collateral available Ongoing ooze Alginate or Kaltostat Seaweed based Promote haemostasis and form a gel Consider Jelonet as further barrier Compression gauze
- 32. Wound Management Mepilex/Mepilex Border Silicone based Uses: Secondary closure E.g ulcers, pressure injuries Skin tears Thick abrasions Mepitel Tacky Useful in skin tears
- 33. References Jamie Bawden,SCGH ED ANP www.lacerationrepair.com https://lifeinthefastlane.com/own-the-wound/ https://hqmeded.com/wound-care-ed/ Wound Care: Modern Evidence in the Treatment of Man’s Age-Old Injuries; Emergency Medicine Practice; March 2005; 7(3) https://www.rch.org.au/clinicalguide/guideline_index/Lacerations/ https://coreem.net/core/suture-materials/