What is the proper treatment for an open wound?

Open Wound Treatment

For open wounds, immediately apply direct pressure with gauze or cloth dressing to control bleeding, and use tourniquets only for life-threatening extremity hemorrhage when direct pressure fails. 1

Initial Bleeding Control

The primary goal in open wound management is hemorrhage control, which directly impacts mortality:

• Apply direct local compression to all open wounds as the first-line intervention for bleeding control 1
• Direct pressure with or without gauze/cloth dressing is effective for most civilian bleeding scenarios 1
• Use tourniquets as an adjunct only when standard bleeding control fails for severe or life-threatening extremity bleeding 1
• Tourniquets are specifically indicated when:
  • Direct pressure is ineffective 1
  • The wound is in locations where tourniquets cannot be applied (trunk, axilla, groin) 1
  • Mass casualty situations or unsafe scenes prevent prolonged direct pressure 1
  • Multiple injuries require triage 1

Critical caveat: Tourniquet application requires proper training with the specific device being used 1. Adverse events are low when applied correctly, but improper use can cause harm 1.

Hemostatic Dressings

• Consider hemostatic dressings only when standard bleeding control with direct pressure fails for severe or life-threatening bleeding 1
• These are most useful for severe external bleeding where tourniquets cannot be applied (junctional areas like abdomen, axilla, groin) 1
• Proper application requires training 1

Wound Cleaning

For traumatic open wounds requiring surgical intervention:

• Use simple saline solution without additives for initial wound irrigation 1
• Additives such as soap or antiseptics provide no additional benefit and are not recommended 1
• This represents strong evidence (Grade 1A recommendation) 1

Special Wound Types

Open Chest Wounds

Do NOT apply occlusive dressings to open chest wounds in the first aid setting 1:

• Occlusive dressings can cause fatal tension pneumothorax 1
• Leave the wound exposed to ambient air without sealing 1
• Activate EMS immediately 1
• Even partial occlusion from standard dressings can cause serious complications 1

Severe Open Fractures

For major extremity trauma with open fractures:

• Initiate systemic antibiotics early (cefazolin or clindamycin for all types) 1
• Add gram-negative coverage (piperacillin-tazobactam preferred) for Gustilo-Anderson Type III fractures 1
• Apply Negative Pressure Wound Therapy (NPWT) between debridement procedures until wound closure 2, 3
• NPWT reduces deep infection risk to 5.4% compared to 28% with standard gauze dressings 2
• Definitive stabilization and primary closure at initial debridement may be appropriate for selected open fractures 1

Topical Antimicrobials

For minor wounds (cuts, scrapes, burns):

• Apply topical bacitracin in a small amount (equal to fingertip surface area) 1-3 times daily 4
• Cover with sterile bandage 4
• This helps prevent infection in minor wounds 4

Advanced Wound Management

Negative Pressure Wound Therapy Indications

Use NPWT for post-surgical wounds and severe traumatic wounds requiring granulation tissue formation 5, 6:

• Strongest evidence exists for closed incision management in high-risk wounds 5
• NPWT significantly reduces wound complications including dehiscence and infection 5
• Apply continuous pressure at 50-80 mmHg (lower pressures for vulnerable patients) 5
• Do NOT use NPWT for non-surgical diabetic foot ulcers (very low certainty evidence) 5

Recalcitrant Stage 3 Wounds

For wounds failing to heal with standard treatment:

• Debride all nonviable tissue first 6
• Apply NPWT as the most effective primary treatment 6
• Obtain cultures before antibiotics if infection is present 6
• Reassess for osteomyelitis, deep infection, or vascular insufficiency if no improvement within 2-4 weeks 6

Critical Pitfalls to Avoid

• Never apply occlusive dressings to chest wounds - risk of tension pneumothorax 1
• Never attempt to straighten angulated fractures without specific training 1
• Do not delay EMS activation for severe bleeding, chest wounds, or suspected fractures 1
• Avoid cervical collar application by first aid providers - causes more harm than benefit 1
• Do not use wound additives (soap, antiseptics) for traumatic wounds - saline alone is superior 1