Kevin P. Kilgore, M.D., FACEP
Overview
The process of wound care involves

evaluation

plan

action
Kevin P. Kilgore, M.D., FACEP
Objectives
Objectives
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Discuss the process of wound evaluation

Review the materials used for wound repair
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Discuss “simple” wound closure

Discuss wound aftercare items
Kevin P. Kilgore, M.D., FACEP
History

When did this happen?


Where did this happen?


time
location
How did this happen?

mechanism
Kevin P. Kilgore, M.D., FACEP
History
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allergies
current medications
pre-existent medical conditions
immunization status for tetanus
Kevin P. Kilgore, M.D., FACEP
History
The “golden period”
A misnomer with:



meticulous debridement
copious irrigation
antibiotic coverage
Kevin P. Kilgore, M.D., FACEP
History
Mechanism
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shear
tension
compression
missile injuries a combination of shear,
tensile, and compressive
Kevin P. Kilgore, M.D., FACEP
History
Shear
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Kevin P. Kilgore, M.D., FACEP
Sharp tissue division
Little energy required
Lower infection rate
Cosmetics acceptable
History
Tension
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
Kevin P. Kilgore, M.D., FACEP
Compression injury
Less than 90o
Triangular flap
Increased infection
Poor result
History
Compression




Kevin P. Kilgore, M.D., FACEP
Crushing injury
Significant injury
Increased infection
Poor results
Examination
Environment

protective dressing
gloves, gowns, goggles
good lighting

goal - determine extent of injury
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
Kevin P. Kilgore, M.D., FACEP
Examination
Extent of injury



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amount of tissue loss
tissue viability
depth of the wound
presence of any associated injuries
Kevin P. Kilgore, M.D., FACEP
Examination
Depth of injury
Injury to underlying structures?




nerves
tendons
muscles
bone
Kevin P. Kilgore, M.D., FACEP
Examination
Lacerations over bones


probe with a gloved finger to determine
whether or not there is a fracture.
If a wound overlies a fracture site an open
fracture should be assumed present.
Kevin P. Kilgore, M.D., FACEP
Examination
Deep structure injury

puncture wounds of the head, neck and
torso must be managed on the premise that
there has been penetration and damage to
vital structures.
Kevin P. Kilgore, M.D., FACEP
Techniques
Anesthesia

Topical


Local



TAC or XAP
1% buffered xylocaine
bupivocaine
Regional (nerve block)


1% buffered xylocaine
bupivocaine
Kevin P. Kilgore, M.D., FACEP
Techniques
Irrigation & debridement


The single most important element of basic
wound care.
Intent:


remove devitalized tissue
remove potential nidus for infection
Kevin P. Kilgore, M.D., FACEP
Techniques
Preparation


Generally, an iodophor solution (e.g.,
Betadine 10%)
Sterile draping is imperative
Kevin P. Kilgore, M.D., FACEP
Techniques
Instruments

four basic instruments

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
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needle-holder
forceps
scissors
towels
Kevin P. Kilgore, M.D., FACEP
Techniques
Suture materials

Absorbable Sutures



employed below the skin
Polyglycolic acid (Dexon®)
Nonabsorbable Sutures



nylon (dermalon®, ethilon®)
surgelene®
novifyl®
Kevin P. Kilgore, M.D., FACEP
Techniques
Other closure materials
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

Steri-Strips® and Shur-strips®
Surgical staples
Dermabond
Kevin P. Kilgore, M.D., FACEP
Techniques
Size Selection


face, hands or feet - 5-0 and 6-0
trunk and extremity - 4-0 and 5-0
Kevin P. Kilgore, M.D., FACEP
Techniques
Suture techniques

Subcuticular Closure


Dexon® or Vicryl®, are used for this deep
layer closure.
Cuticular Closure
Kevin P. Kilgore, M.D., FACEP
Techniques
Subcuticular Closure
Kevin P. Kilgore, M.D., FACEP
Techniques
Simple Suture



Kevin P. Kilgore, M.D., FACEP
easiest to learn
safest & most effective
more time needed
Techniques
Wound Edge Eversion
Kevin P. Kilgore, M.D., FACEP
Techniques
Instrument Tie
Kevin P. Kilgore, M.D., FACEP
Completing Care
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Dressings
Immobilization
Medications
Antibiotics
Tetanus Prophylaxis
Rabies Prophylaxis
Discharge Instructions
Kevin P. Kilgore, M.D., FACEP
Completing Care
Suture Removal
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face
ear
scalp
trunk
arms
legs
hand
feet
3 to 5 days
4 to 6 days
7 to 12 days
7 to 12 days
10 to 12 days
10-12 days
10 to 12 days
10 to 14 days
Kevin P. Kilgore, M.D., FACEP
Objective Review





Discuss the process of wound evaluation
Review the materials used for wound repair
Discuss “simple” wound closure
Discuss wound aftercare items
Remember to remove your sharps from the
tray
Kevin P. Kilgore, M.D., FACEP
Now to the Lab