What is the proper procedure for wound care and stitches?

Proper Procedure for Wound Care and Stitches

For wounds requiring stitches, thorough irrigation with warm or room temperature potable water is essential, followed by application of antibiotic ointment and a clean occlusive dressing to reduce infection risk and improve healing outcomes. 1

Initial Wound Assessment and Cleaning

1. Wound Cleansing:

   • Thoroughly irrigate the wound with a large volume (100-1000 mL) of warm or room temperature potable water with or without soap until there is no foreign matter in the wound (Class I, LOE A) 1, 2
   • Remove all inorganic residues (foreign bodies) and dead tissue before applying any antiseptics 3
   • Pressure irrigation with saline may be more effective than standard irrigation for removing bacterial contamination 2

2. Wound Disinfection:

   • After cleaning, apply an appropriate antiseptic
   • Avoid using antiseptics in wounds with granulation tissue or near the eyes 3
   • Do not use povidone iodine in pregnant women, and avoid iodine preparations in neonates, patients with thyroid disorders, or those with iodine allergies 3

Wound Closure (Stitches)

1. When to Suture:

   • Suture wounds that are deep, gaping, or in cosmetically important areas
   • Avoid suturing animal bite wounds when possible due to high infection risk 2

2. Suturing Technique:

   • Use appropriate suture material based on wound location and depth
   • Apply steri-strips for superficial wounds (should fall off naturally within 5-10 days) 2
   • Consider tissue adhesives for small, clean lacerations in low-tension areas

3. Special Considerations:

   • Hand injuries require special attention due to higher infection risk and proximity to tendons and joints 2
   • Deep puncture wounds may require more extensive irrigation and antibiotic prophylaxis 2

Post-Closure Wound Care

1. Dressing Application:

   • Cover with antibiotic ointment or cream and a clean occlusive dressing (Class IIa, LOE A) 1
   • For superficial wounds, use a sterile, inert dressing to keep the wound moist 2
   • For wounds with signs of infection, consider antimicrobial dressings (silver-containing, iodine, or medical-grade honey) 2

2. Dressing Selection Based on Wound Type:

   • Dry wounds: Consider hydrogel dressings 2
   • Exudative wounds: Use foam dressings to absorb exudate 2
   • Non-infected wounds: Collagen matrix dressings can promote dermal fibroblast proliferation 2

Infection Prevention

1. Antibiotic Use:

   • For high-risk wounds (animal bites, deep punctures), consider prophylactic antibiotics:
     • Amoxicillin-clavulanate 875/125 mg twice daily for 3-5 days 2
     • For penicillin-allergic patients: Doxycycline 100 mg twice daily, or Clindamycin 300 mg three times daily plus either a fluoroquinolone or trimethoprim-sulfamethoxazole 2
   • Avoid first-generation cephalosporins for animal bites due to poor activity against Pseudomonas 2

2. Tetanus Prophylaxis:

   • Ensure tetanus immunization is current 2

Follow-up Care

1. Monitoring:

   • Schedule follow-up within 24-48 hours, especially for high-risk wounds 2
   • Monitor for signs of infection: increasing redness, warmth, swelling, pain, or purulent discharge 2

2. Patient Education:

   • Keep the wound clean and dry 2
   • Do not remove steri-strips prematurely 2
   • Seek immediate medical attention if signs of infection develop 2

Special Wound Situations

1. Animal Bites:

   • Irrigate with copious amounts of water (Class I, LOE B) 1
   • Consider rabies prophylaxis in consultation with local health officials 2
   • Administer rabies immune globulin (20 IU/kg) if indicated, infiltrating around the wound 2

2. High-Risk Patients:

   • Provide closer monitoring and early antibiotic therapy for immunocompromised patients or those with diabetes 2
   • Deep wounds on extremities require thorough irrigation and appropriate wound care 2

By following these evidence-based guidelines for wound care and stitches, you can minimize infection risk, promote optimal healing, and reduce complications that could lead to increased morbidity and mortality.