What is the proper treatment for a wound?

Proper Treatment for Wounds

Wounds should be thoroughly irrigated with running tap water or sterile saline until all visible debris and foreign matter are removed, then covered with an occlusive dressing to promote healing. 1

Initial Wound Assessment and Cleaning

1. Irrigation and Cleansing:

   • Use running tap water or sterile saline solution for wound irrigation 1
   • Avoid antiseptic agents such as povidone-iodine as they show no additional benefit 1
   • Ensure thorough irrigation to remove all visible debris and foreign matter 1

2. Special Considerations:

   • For wounds caused by animal or human bites or contaminated with saliva, seek immediate medical evaluation 1
   • For wounds with significant bleeding, apply direct pressure to control hemorrhage before cleaning

Wound Dressing Selection

Choose dressings based on wound characteristics 2:

• Dry/necrotic wounds:

  • Continuously moistened saline gauze
  • Hydrogels (facilitate autolysis)

• Exudative wounds:

  • Alginates (for drying exudate)
  • Foams

• General wound coverage:

  • Occlusive dressings (films, hydrocolloids) - promote better wound healing than dry dressings 1
  • Films - for moistening dry wounds
  • Hydrocolloids - absorb exudate and facilitate autolysis

Monitoring and Follow-up

• Signs requiring medical attention 1:

  • Redness extending beyond wound edges
  • Swelling
  • Foul-smelling drainage
  • Increased pain
  • Fever

• Dressing changes:

  • Change dressings regularly to allow for wound inspection 2
  • For infected wounds, follow-up within 2-3 days
  • For initially uninfected wounds, follow-up within 7-10 days

Special Wound Types

1. Diabetic Foot Wounds 1, 2:

   • Require specialized care with appropriate offloading
   • May need debridement of callus and nonviable tissue
   • Assess vascular status and consider revascularization if ischemic

2. Infected Wounds 2:

   • Obtain deep tissue specimens for culture before starting antibiotics if possible
   • Select antibiotics based on infection severity
   • Consider surgical debridement for moderate to severe infections

Common Pitfalls to Avoid

• Avoid topical antimicrobials for most clinically uninfected wounds 1
• Avoid routine use of antibiotic or antibacterial dressings for clean wounds 1
• Avoid using honey or bee-related products for diabetic foot ulcers 2
• Avoid delayed recognition of infection signs, which can lead to serious complications 2
• Avoid using povidone-iodine for routine wound cleaning, as it shows no benefit over tap water or saline 1

When to Seek Medical Care

• Wounds that are deep, gaping, or have jagged edges
• Wounds with embedded foreign objects
• Animal or human bite wounds
• Wounds showing signs of infection
• Wounds that fail to show improvement within 48-72 hours
• Wounds in individuals with diabetes, peripheral vascular disease, or immunocompromise

By following these evidence-based guidelines for wound management, you can promote optimal healing and minimize the risk of complications such as infection and delayed healing.