Acute wound management: revisiting the approach to assessment, irrigation, and closure considerations

Bret A Nicks, Elizabeth A Ayello, Kevin Woo, Diane Nitzki-George, R Gary Sibbald, Bret A Nicks, Elizabeth A Ayello, Kevin Woo, Diane Nitzki-George, R Gary Sibbald

Abstract

Background: As millions of emergency department (ED) visits each year include wound care, emergency care providers must remain experts in acute wound management. The variety of acute wounds presenting to the ED challenge the physician to select the most appropriate management to facilitate healing. A complete wound history along with anatomic and specific medical considerations for each patient provides the basis of decision making for wound management. It is essential to apply an evidence-based approach and consider each wound individually in order to create the optimal conditions for wound healing.

Aims: A comprehensive evidence-based approach to acute wound management is an essential skill set for any emergency physician or acute care practitioner. This review provides an overview of current evidence and addresses frequent pitfalls.

Methods: A systematic review of the literature for acute wound management was performed.

Results: A structured MEDLINE search was performed regarding acute wound management including established wound care guidelines. The data obtained provided the framework for evidence-based recommendations and current best practices for wound care.

Conclusion: Acute wound management varies based on the wound location and characteristics. No single approach can be applied to all wounds; however, a systematic approach to acute wound care integrated with current best practices provides the framework for exceptional wound management.

Keywords: Acute tissue injury; Assessment; Cleansing; Closure; Irrigation; Wound; Wound assessment; Wound closure; Wound irrigation.

Figures

Fig. 1
Fig. 1
Wound bed preparation and DIM-E model [–44]

References

    1. Pitts SR, Niska RW, Xu J, Burt CW. National hospital ambulatory medical care survey: 2006 Emergency department summary. National Health Care Statistics. 2008;6(7):1–40.
    1. Hollander JE, Singer AJ, Valentine SM, Shofer FS. Risk factors for infection in patients with traumatic lacerations. Acad Emerg Med. 2001;8(7):716–720. doi: 10.1111/j.1553-2712.2001.tb00190.x.
    1. Singer AJ, Dagum AB. Current management of acute cutaneous wounds. N Engl J Med. 2008;359(10):1037–1046. doi: 10.1056/NEJMra0707253.
    1. Barbul A, et al. Wound healing. In: Brunicardi FC, Andersen DK, Billiar TR, et al., editors. Schwartz’s principles of surgery. Eighth. Columbus: The McGraw-Hill Companies, Inc; 2005. pp. 165–182.
    1. Woo K, Ayello EA, Sibbald RG. The edge effect: current therapeutic options to advance the wound edge. Adv Skin Wound Care. 2007;20(2):99–117. doi: 10.1097/00129334-200702000-00009.
    1. Percival NJ. Classification of wounds and their management. Surgery. 2002;20(5):114–117.
    1. Berk WA, Welch RD, Bock BF. Controversial issues in clinical management of the simple wound. Ann Emerg Med. 1992;21(1):72–80. doi: 10.1016/S0196-0644(05)82245-0.
    1. Chisholm CD. Wound evaluation and cleansing. Emerg Med Clin North Am. 1992;10(4):665–672.
    1. Lammers RL, Hudson DL, Seaman ME. Prediction of traumatic wound infection with a neural network-derived decision model. Am J Emerg Med. 2003;21(1):1–7. doi: 10.1053/ajem.2003.50026.
    1. Frank M, Schmucker U, Hinz P, Zach A, Ekkernkamp A, Matthes G. Not another 4th of July report: uncommon blast injuries to the hand. Emerg Med J. 2008;25(2):93–97. doi: 10.1136/emj.2007.052316.
    1. Zempsky WT, Cravero JP. Relief of pain and anxiety in pediatric patients in emergency medical systems. Pediatrics. 2004;114(5):1348–1356. doi: 10.1542/peds.2004-1752.
    1. Bonadio WA. Safe and effective method for application of tetracaine, adrenaline, and cocaine to oral lacerations. Ann Emerg Med. 1996;28(4):396–398. doi: 10.1016/S0196-0644(96)70003-3.
    1. Ernst AA, Marvez-Valls E, Nick TG, Mills T, Minvielle L, Houry D. Topical lidocaine adrenaline tetracaine (LAT gel) versus injectable buffered lidocaine for local anesthesia in laceration repair. West J Med. 1997;167(2):79–81.
    1. Railan D, Alster TS. Use of topical lidocaine for cosmetic dermatologic procedures. J Drugs Dermatol. 2007;6(11):1104–1108.
    1. Kundu S, Achar S. Principles of office anesthesia: part II. Topical anesthesia. Am Fam Physician. 2002;66(1):99–102.
    1. Scarfone RJ, Jasani M, Gracely EJ. Pain of local anesthetics: Rate of administration and buffering. Ann Emerg Med. 1998;31(1):36–40. doi: 10.1016/S0196-0644(98)70278-1.
    1. Brogan GX, Singer AJ, Valentine SM, et al. Comparison of wound infection rates using plain versus buffered lidocaine for anesthesia of traumatic wounds. Am J Emerg Med. 1997;15:25–28. doi: 10.1016/S0735-6757(97)90042-5.
    1. Thyssen JP, Menné T, Elberling J, Plaschke P, Johansen JD. Hypersensitivity to local anaesthetics–update and proposal of evaluation algorithm. Contact Dermat. 2008;59(2):69–78. doi: 10.1111/j.1600-0536.2008.01366.x.
    1. Daya MR, Burton BT, Schleiss MR, DiLiberti JH. Recurrent seizures following mucosal application of TAC. Ann Emerg Med. 1988;17(6):646–648. doi: 10.1016/S0196-0644(88)80409-8.
    1. Dailey RH. Fatality secondary to misuse of TAC solution. Ann Emerg Med. 1988;17(2):159–160. doi: 10.1016/S0196-0644(88)80303-2.
    1. Howell JM, Chisholm CD. Outpatient wound preparation and care: a national survey. Ann Emerg Med. 1992;21(8):976–981. doi: 10.1016/S0196-0644(05)82938-5.
    1. Pfaff JA, Moore GP. Reducing risk in emergency department wound management. Emerg Med Clin N Am. 2007;25:189–201. doi: 10.1016/j.emc.2007.01.009.
    1. Singer AJ, Hollander JE, Subramanian S, Malhotra AK, Villez PA. Pressure dynamics of various irrigation techniques commonly used in the emergency department. Ann Emerg Med. 1994;24(1):36–40. doi: 10.1016/S0196-0644(94)70159-8.
    1. Longmire AW, Broom LA, Burch J. Wound infection following high-pressure syringe and needle irrigation. Am J Emerg Med. 1987;5(2):179–81. doi: 10.1016/0735-6757(87)90121-5.
    1. Rodeheaver GT, Ratliff . Wound cleansing, wound irrigation, wound disinfection. In: Krasner D, Rodeheaver G, Sibbald RG, editors. Chronic wound care, Chapter 34. Malvern: HMP Communications; 2008.
    1. Chisholm CD, Cordell WH, Rogers K, Woods JR. Comparison of a new pressurized saline canister versus syringe irrigation for laceration cleansing in the emergency department. Ann Emerg Med. 1992;21(11):1364–1367. doi: 10.1016/S0196-0644(05)81903-1.
    1. Grotz MR, Allami MK, Harwood P, Pape HC, Krettek C, Giannoudis PV. Open pelvic fractures: epidemiology, current concepts of management and outcome. Injury. 2005;36(1):1–13. doi: 10.1016/j.injury.2004.05.029.
    1. Fernandez R, Griffiths R. Water for wound cleansing. Cochrane Database Syst Rev. 2008;23(1):CD003861.
    1. Khan MN, Naqvi AH. Antiseptics, iodine, povidone iodine and traumatic wound cleansing. J Tissue Viability. 2006;16(4):6–10.
    1. Watt BE, Proudfoot AT, Vale JA. Hydrogen peroxide poisoning. Toxicol Rev. 2004;23(1):51–57. doi: 10.2165/00139709-200423010-00006.
    1. Cartotto RC, Peters WJ, Neligan PC, Douglas LG, Beeston J. Chemical burns. Can J Surg. 1996;39(3):205–211.
    1. Lee CK, Hansen SL. Management of acute wounds. Clin Plast Surg. 2007;34:685–696. doi: 10.1016/j.cps.2007.08.011.
    1. Tetanus and tetanus toxoid: epidemiology and prevention of vaccine-preventable diseases. National Immunization Program Centers for Disease Control and Prevention. Center for Disease Control Web site. As found at: accessed on 2/25/2009.
    1. Eron LJ. Targeting lurking pathogens in acute traumatic and chronic wounds. J Emerg Med. 1999;17(1):189–195. doi: 10.1016/S0736-4679(98)00149-8.
    1. Hankin A, Everett WW. Are antibiotics necessary after incision and drainage of a cutaneous abscess? Ann Emerg Med. 2007;50(1):49–51. doi: 10.1016/j.annemergmed.2007.01.018.
    1. Edlich RF, Rodeheaver GT, Morgan RF, et al. Principles of emergency wound management. Ann Emerg Med. 1988;17:1284–1302. doi: 10.1016/S0196-0644(88)80354-8.
    1. Ichikawa S, Ishihara M, Okazaki T, et al. Prospective study of antibiotic protocols for managing surgical site infections in children. J Pediatr Surg. 2007;42(6):1002–1007. doi: 10.1016/j.jpedsurg.2007.01.034.
    1. Farion KJ, Osmond MH, Hartling L, et al. Tissue adhesives for traumatic lacerations: a systematic review of randomized controlled trials. Acad Emerg Med. 2003;10(2):110–118. doi: 10.1111/j.1553-2712.2003.tb00027.x.
    1. Lloyd JD, Marque MJ, Kacprowicz RF. Closure Techniques. Emerg Med Clin North Am. 2007;25(1):73–81. doi: 10.1016/j.emc.2007.01.002.
    1. Fonder MA, Mamelak AJ, Lazarus GS, Chanmugam A. Occlusive wound dressings in emergency medicine and acute care. Emerg Med Clin North Am. 2007;25(1):235–242. doi: 10.1016/j.emc.2007.01.012.
    1. Davidson JM, Breyer MD. Inflammatory modulation and wound repair. J Invest Dermatol. 2003;120(5):xi–xii. doi: 10.1046/j.1523-1747.2003.12154.x.
    1. Sibbald RG, Orsted H, Schultz GS, Coutts P, Keast D. International Wound Bed Preparation Advisory Board, Canadian Chronic Wound Advisory Board. Preparing the wound bed 2003: focus on infection and inflammation. Ostomy/Wound Manage. 2003;49(11):23–51.
    1. Sibbald RG, Orsted HL, Coutts PM, Keast DL. Best practice recommendations for preparing the wound bed: update 2006. Adv Skin Wound Care. 2007;20:390–405. doi: 10.1097/01.ASW.0000280200.65883.fd.
    1. Sibbald RG, Williamson D, Orsted HL, et al. Preparing the wound bed: debridement, bacterial balance and moisture balance. Ostomy/Wound Manage. 2000;46(11):14–35.
    1. Stone S, Carter WA. Wound preparation. In: Tintinalli JE, Kelen GD, Stapczynski JS, Ma OJ, Clin DM, editors. Tintinalli’s emergency medicine. New York: The McGram-Hill Companies, Inc; 2004. pp. 284–287.

Source: PubMed

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