Acute Wounds


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Acute Wounds

There are principally two types of acute wound; traumatic wounds and surgical wounds1.

A traumatic wound such as a minor cut, abrasion through to extensive tissue injuries are caused when a force exceeds the strength of the skin or the underlying supporting tissues. A traumatic wound is classified by whether or not it is tidy or untidy.

A surgical wound is either incised and suture or laid open to heal by a surgeon. The wound breaks the integrity of the skin including the epidermis and dermis. Surgical wounds are classified in relation to the potential for infection in the wound: they are considered to be either clean, clean contaminated, contaminated or dirty. Surgical wounds which are contaminated / dirty or infected are sometimes left open post surgery whilst the infection resolves and then they are sutured closed. This is known as ‘delayed primary closure’. Premature primary closure in these instances can be detrimental to a successful outcome.

Management of a severe traumatic wound initially involves emergency procedures; resuscitation and restoration of the circulation to the affected limb / area. Associated injuries should be considered. The blood supply must be optimised, any necrotic tissue debrided away as this can act as a focal point for bacteria, and the wound irrigated. Antibiotics and tetanus are usually given prophylactically.

The correct intervention can greatly affect the outcome for the patient: the scar, time to heal and quality of life. With any acute wound the post-operative function of the wounded area and adequate pain control is essential. If pain is not controlled adequately it can decrease oxygen uptake, increase mortality and morbidity, delay mobility and increase hospital length of stay.

For these wound types, dressing selection should be based upon absorbing wound exudate, supporting haemostasis and protecting the wound from infection. It is also critical to manage the peri-wound area. Exudate levels can be high during the inflammatory phase and leakage of corrosive exudate onto the surrounding skin under the dressing can lead to ‘blistering’. Protection of the peri-wound area with a ‘no sting’ barrier film preparation such as LBF may be appropriate2.

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References:
1 Leaper DJ and Harding KG. (1998) Wounds: Biology and Management. Oxford University Press.
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Caveat: The information given is a guide only and should not replace clinical judgement.