Management of a Non-Infected Wound on the Forearm Open to the Subcutaneous Tissue
The primary management for a non-infected wound on the forearm that is open to the subcutaneous tissue should focus on proper wound cleansing, moist wound healing environment, and close monitoring without antibiotics. 1, 2
Initial Assessment and Wound Care
- The wound should be thoroughly cleansed with sterile normal saline or potable tap water to remove any debris or contaminants 2
- After cleansing, the wound should be evaluated for signs of infection such as pain, swelling, erythema, and purulent drainage 1
- Since the wound is non-infected but open to the subcutaneous tissue, it should be managed with the principles of moist wound healing 2
Treatment Approach
Primary Interventions
- Open the wound if necessary to ensure adequate drainage and visualization of all tissue planes 1
- Debridement of devitalized tissue may be necessary, but should be done cautiously to avoid enlarging the wound unnecessarily 1
- Apply appropriate dressing that maintains a moist wound environment, such as hydroactive colloid gels that combine attributes of hydrocolloids and hydrogels 2
Antibiotic Management
- Antibiotics are not necessary for non-infected wounds with minimal surrounding erythema and induration, and when the patient has no systemic signs of infection (temperature <38.5°C and pulse rate <100 beats/min) 1
- Studies have shown no benefit for antibiotic therapy when combined with proper wound care for uncomplicated wounds 1
Wound Closure Considerations
- For a wound open to the subcutaneous tissue, secondary intention healing or delayed primary closure may be appropriate depending on wound characteristics 1
- Suturing should be avoided in potentially contaminated wounds that have been open for >8 hours 1
Follow-up Care
- The wound should be inspected regularly for signs of infection 1
- Dressing changes should be performed 2-3 times daily with continued wound cleansing 2
- Elevation of the forearm, especially if swollen, accelerates healing and should be accomplished 1
Warning Signs Requiring Additional Intervention
- If the patient develops fever >38.5°C or pulse rate >100 beats/min, a short course of antibiotics (24-48 hours) may be indicated 1
- Any signs of spreading infection (>5 cm of erythema and induration) would warrant antibiotic therapy and possible surgical consultation 1
- Pain disproportionate to the severity of injury should raise suspicion for deeper tissue involvement 1
Special Considerations
- Hand and forearm wounds require special attention due to the complex anatomy and potential for functional impairment 1
- The subcutaneous tissue provides a favorable environment for microorganisms to contaminate and colonize if the tissue becomes devitalized 1
- Smoking significantly reduces collagen deposition in subcutaneous tissue, potentially impairing wound healing 3
By following these guidelines, most non-infected wounds open to the subcutaneous tissue will heal properly without complications. The focus should remain on proper wound cleansing, maintaining a moist healing environment, and vigilant monitoring for signs of infection.