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atment of a simple wound
Wound excision
– T h e go al o f th e excisio n is to rem o ve no n- viab le tissue, w h ich favo urs th e
p ro liferatio n o f bacteria and infectio n.
– T h e w o und m ay require little o r no excisio n if it is clean. T h e excisio n is m o re
extensive if the wo und is bruised , irregular o r extensive.
– L im it excisio n o f the sk in aro und the wo und , p articularly in facial wo und s.
– S ub- cutaneo us fat and tissue o f d o ubtful viability sho uld be genero usly excised in
o rd er to leave o nly well vascularised tissue.
Immediate suturing of a simple wound
– Im m ed iate suturing m ay have serio us co nsequences fo r the p atient if p recautio ns to
p revent infectio n and p ro m o te healing are no t tak en.
– T he d ecisio n to suture im m ed iately can o nly be tak en after the cleaning, exp lo ratio n and
satisfacto ry excisio n, and if the fo llo wing co nd itio ns are m et: sim p le wo und , no m o re
than 6 ho urs o ld with no d evitalised o r co ntused tissue (the wo und m ay be as lo ng as
2 4 ho urs o ld if o n the face, scalp , up p er lim bs o r hand s).
– B ites (fo r lo cal treatm ent see Rabies, p age 1 9 4 ) and bullet, shell o r m ine shrap nel wo und s
sho uld no t be im m ed iately sutured .
Delayed suturing of a simple wound
– W o und s that d o no t fill the abo ve co nd itio ns sho uld no t be im m ed iately sutured .
– A fter cleaning, exp lo ratio n and excisio n a sim p le d ressing is ap p lied to th e o p en
wo und .
– F urther cleaning and rem o val o f any rem aining necro tic tissue is co m p leted with
d aily d ressing changes.
– If after 7 2 ho urs there are no signs o f lo cal infectio n, the wo und m ay be sutured .
Healing by second intention of infected wounds
If the wo und d o es no t m eet the co nd itio ns o f cleanliness d escribed abo ve, the wo und
canno t be sutured . It will heal either sp o ntaneo usly (healing by seco nd ary intentio n), o r
will require a sk in graft (o nce the wo und is clean) if there is significant lo ss o f tissue.
258
Wound excision
– T h e go al o f th e excisio n is to rem o ve no n- viab le tissue, w h ich favo urs th e
p ro liferatio n o f bacteria and infectio n.
– T h e w o und m ay require little o r no excisio n if it is clean. T h e excisio n is m o re
extensive if the wo und is bruised , irregular o r extensive.
– L im it excisio n o f the sk in aro und the wo und , p articularly in facial wo und s.
– S ub- cutaneo us fat and tissue o f d o ubtful viability sho uld be genero usly excised in
o rd er to leave o nly well vascularised tissue.
Immediate suturing of a simple wound
– Im m ed iate suturing m ay have serio us co nsequences fo r the p atient if p recautio ns to
p revent infectio n and p ro m o te healing are no t tak en.
– T he d ecisio n to suture im m ed iately can o nly be tak en after the cleaning, exp lo ratio n and
satisfacto ry excisio n, and if the fo llo wing co nd itio ns are m et: sim p le wo und , no m o re
than 6 ho urs o ld with no d evitalised o r co ntused tissue (the wo und m ay be as lo ng as
2 4 ho urs o ld if o n the face, scalp , up p er lim bs o r hand s).
– B ites (fo r lo cal treatm ent see Rabies, p age 1 9 4 ) and bullet, shell o r m ine shrap nel wo und s
sho uld no t be im m ed iately sutured .
Delayed suturing of a simple wound
– W o und s that d o no t fill the abo ve co nd itio ns sho uld no t be im m ed iately sutured .
– A fter cleaning, exp lo ratio n and excisio n a sim p le d ressing is ap p lied to th e o p en
wo und .
– F urther cleaning and rem o val o f any rem aining necro tic tissue is co m p leted with
d aily d ressing changes.
– If after 7 2 ho urs there are no signs o f lo cal infectio n, the wo und m ay be sutured .
Healing by second intention of infected wounds
If the wo und d o es no t m eet the co nd itio ns o f cleanliness d escribed abo ve, the wo und
canno t be sutured . It will heal either sp o ntaneo usly (healing by seco nd ary intentio n), o r
will require a sk in graft (o nce the wo und is clean) if there is significant lo ss o f tissue.
258
