From the Guidelines
I strongly recommend performing a local wound exploration on this patient if the wound is a penetrating injury that may have breached the peritoneum, as this approach can help confirm peritoneal breaching and guide further management, as suggested by the WSES guidelines 1.
Key Considerations
- The procedure involves extending the wound under local anesthesia to visualize the fascial layer and determine if it has been penetrated.
- Local wound exploration is particularly useful in penetrating trauma to confirm peritoneal breaching, and if positive, serial clinical examinations should follow, with diagnostic or therapeutic laparoscopy or laparotomy warranted if there is clinical suspicion for bowel injury 1.
- The decision to perform local wound exploration should be based on the patient's clinical presentation, the mechanism of injury, and the surgeon's experience and judgment.
Important Details
- The WSES guidelines recommend local wound exploration in penetrating trauma to confirm peritoneal breaching, with a moderate grade of recommendation 1.
- The procedure requires proper lighting, sterile technique, and instruments, including a scalpel, forceps, and retractors.
- If the fascia is intact, the wound can typically be managed conservatively, but if the fascia is violated, further diagnostic studies or surgical exploration may be necessary.
Additional Considerations
- It is essential to consider the patient's overall clinical condition, including hemodynamic stability and the presence of any other injuries, when deciding whether to perform local wound exploration.
- The procedure should not be performed for obvious superficial wounds, wounds with clear evidence of deep structure involvement requiring immediate surgical intervention, or in uncooperative patients.
From the Research
Local Wound Exploration
- The decision to perform a local wound exploration should be based on the individual patient's condition and the specific characteristics of the wound.
- According to 2, the management of acute wounds requires a multidisciplinary approach, and local wound exploration may be necessary to assess the extent of the wound and identify potential complications.
- However, there is no direct evidence in the provided studies to support the routine use of local wound exploration for all patients with wounds.
- The studies focus on the management of acute and chronic wounds, including the use of topical antimicrobial agents 3, wound healing phases 4, and the diagnosis and treatment of local wound infections 5, 6.
Wound Assessment and Management
- A thorough assessment of the wound is essential to determine the best course of treatment, including the potential need for local wound exploration.
- The use of tools such as the TILI score and the W.A.R. score can help identify patients with an increased risk of infections and guide treatment decisions 5.
- The management of acute wounds requires timely and evidence-driven intervention to achieve optimal clinical outcomes, including the prevention of infection and promotion of wound healing 6.