What is the proper procedure for dressing a wound laceration?

Proper Procedure for Dressing a Wound Laceration

Wound lacerations should be thoroughly irrigated with running tap water or sterile saline until free of debris, followed by application of an occlusive dressing to promote healing and prevent infection. 1

Initial Wound Assessment and Preparation

1. Assess the wound:

   • Determine depth, location, and contamination level
   • Check for foreign bodies or debris
   • Evaluate for potential underlying structure damage

2. Clean the wound:

   • Irrigate thoroughly with running tap water or sterile saline 1
   • Use sufficient pressure and volume (100-1000 mL) to remove debris 1
   • Avoid antiseptic agents like povidone-iodine as they offer no additional benefit 1

3. Special considerations:

   • Animal or human bite wounds require immediate medical evaluation 1
   • Deep lacerations with significant tissue damage may require surgical evaluation

Wound Dressing Application

Step 1: Select Appropriate Dressing

Choose based on wound characteristics:

• Exudative wounds: Alginates or foam dressings to absorb excess fluid 1, 2
• Dry wounds: Hydrogels or continuously moistened saline gauze 1, 2
• Clean lacerations: Occlusive film, hydrocolloid, or petrolatum-based dressings 1, 2

Step 2: Apply Dressing

1. Ensure hands are clean
2. Apply dressing to cover entire wound with margin extending beyond wound edges
3. Secure dressing appropriately without excessive pressure
4. For occlusive dressings, ensure good seal around wound edges 1

Step 3: Secure Dressing

• Use appropriate tape, bandage, or wrap based on location
• Ensure dressing remains in place but doesn't restrict circulation
• Consider location and movement patterns when securing

Follow-up Care

1. Dressing changes:

   • Change dressing if it becomes soiled, wet, or dislodged
   • Inspect wound during dressing changes for signs of infection
   • Continue occlusive dressing until wound healing is complete 1

2. Monitor for infection:

   • Watch for redness, swelling, increased pain, foul-smelling drainage, or fever 1
   • If signs of infection develop, remove dressing, inspect wound, and seek medical care 1

Evidence-Based Considerations

• Irrigation solution: Tap water is as effective as sterile saline for wound irrigation 1
• Dressing type: Occlusive dressings promote faster healing than dry dressings 1, 2
• Antimicrobial agents: Routine use of topical antimicrobials for clean wounds is not recommended 1
• Technique: Clean technique (vs. sterile) is adequate for most acute wound care 3

Common Pitfalls to Avoid

1. Inadequate irrigation: Insufficient cleaning increases infection risk
2. Inappropriate dressing: Using dry gauze can delay healing and increase scarring
3. Delayed care: Animal/human bite wounds require prompt medical evaluation 1
4. Overlooking tetanus status: Consider tetanus prophylaxis for contaminated wounds 4
5. Excessive pressure: External fixation that's too tight can cause tissue ischemia

The evidence strongly supports that proper wound cleaning with tap water or saline followed by application of an occlusive dressing provides the optimal environment for wound healing while preventing infection. This approach maintains wound moisture, facilitates autolytic debridement, reduces pain, and promotes faster healing with less scarring 1, 5, 2.