What is the best way to manage a simple abrasion wound?

Management of Simple Abrasion Wounds

After cleaning a simple abrasion with copious irrigation, cover it with a topical antibiotic ointment and an occlusive dressing to maintain moisture and prevent infection. 1

Initial Wound Cleaning

Irrigate the abrasion thoroughly with large volumes of warm or room temperature tap water until all visible foreign matter and debris are completely removed. 1 The evidence strongly supports that:

• Tap water is as effective as sterile saline for wound irrigation and reduces infection rates equally well 1
• Warm or room temperature water is more comfortable than cold water, though both are equally effective 1
• Soap and water together are more effective than saline irrigation alone for removing contaminants 1
• High irrigation volumes (100-1000 mL range) and higher pressures are more effective than lower volumes and pressures 1

Do not use antiseptic solutions like povidone-iodine for initial irrigation - there is no evidence they improve outcomes over simple tap water. 2

Wound Dressing Protocol

After thorough cleaning, the American Heart Association and American Red Cross guidelines establish a clear two-step approach:

1. Apply a topical antibiotic ointment (such as bacitracin or triple antibiotic) to the cleaned abrasion 1

   • Apply a small amount equal to the surface area of a fingertip, 1-3 times daily 3
   • This significantly reduces infection rates compared to no antibiotic treatment 4
   • Bacitracin and neomycin/bacitracin/polymyxin combinations show the lowest infection rates (4.5-5.5%) versus petrolatum alone (17.6%) 4

2. Cover with a clean occlusive dressing that keeps the wound moist and prevents drying 1, 2

   • Occlusive dressings demonstrate significantly shorter healing times versus no dressing 1
   • The moist environment promoted by occlusive coverage accelerates epithelial regeneration 2
   • May be covered with a sterile bandage 3

Follow-Up Care

Instruct patients to:

• Inspect and redress the wound 1-3 times daily with fresh antibiotic ointment and clean dressing 3, 4
• Keep the wound clean but it can get wet within 24-48 hours without increasing infection risk 5
• Elevate the injured area during the first few days to reduce inflammation 2

Tetanus Prophylaxis

Verify tetanus immunization status - administer tetanus toxoid if the patient has not received a booster in the past 10 years or if vaccination history is unknown. 2, 5

Infection Monitoring

Watch for these infection signs that require medical attention:

• Progressive redness spreading beyond the wound edges 2
• Increasing pain or tenderness 2
• Warmth and swelling 2
• Purulent discharge or foul odor 2
• Fever or systemic symptoms 2

Critical Pitfalls to Avoid

• Never apply ice directly to abrasions - it can cause tissue ischemia 1
• Do not use prophylactic oral antibiotics for simple abrasions - there is no evidence they improve outcomes 5
• Avoid leaving wounds open to air - this "dry healing" approach increases infection rates and delays healing compared to moist occlusive dressing 1
• Do not scrub aggressively - remove only superficial debris as deeper debridement may impair healing 6