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Principles of Wound Management. Abdelrahman S-E Imbabi, FRCSEd Assistant Professor of Surgery University of Khartoum. Traumatic Wounds. Usually untidy Damage to tissues is extensive, and extent unclear – such as gunshot or blast injuries, crush injuries, lacerations or burns And contaminated

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Principles of wound management l.jpg

Principles of Wound Management

Abdelrahman S-E Imbabi, FRCSEd

Assistant Professor of SurgeryUniversity of Khartoum


Traumatic wounds l.jpg
Traumatic Wounds

  • Usually untidy

    • Damage to tissues is extensive, and extent unclear – such as gunshot or blast injuries, crush injuries, lacerations or burns

  • And contaminated

    • Most traumatic wounds are potentially contaminated, and hence likely to be infected


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Aim of managing wounds

  • To obtain healing by primary intention

    • Quick and easy

    • Smaller scars

    • Less contracture and deformity

    • Better looking


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Healing of untidy wounds

  • With untidy or infected wounds, loss of tissue is extended, and primary healing cannot be achieved

  • Such wounds heal by secondary intention

    • Prolonged and complicated healing process

    • Involves much fibrous tissue and scarring

    • Gross contractures and deformity

    • Ugly appearance


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Dealing with untidy wounds

  • The prime aim is to convert untidy and contaminated or infected wounds to tidy clean wounds which can heal by primary intention


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How can this be achieved

  • All dead and devitalized tissues MUST BE REMOVED

  • All dirt and gross contamination should be physically washed out, or picked up by forceps

  • Avoid further injury to surrounding healthy tissues



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Wounds less than 6 hours

  • Generally, wounds less than 6 hours old may be closed primarily (preferably with drain), however, it is safer practice to leave the wound open, and re-evaluate after 3-5 days, whence if the wound is clean perform a delayed primary closure.

  • Broad spectrum antibiotic cover

  • Anti-tetanus prophylaxis


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Wounds more than 6 hours

  • For wounds older than 6 hours, or there is evidence of gross infection, or vitality of surrounding tissues is in doubt:

    • Keep the wound open

    • Take culture swabs and start broad spectrum antibiotics, modified later according to culture and sensitivity

    • Anti-tetanus prophylaxis

    • Re-evaluate the wound daily and debride as necessary (may require more frequent dressings)


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Then what ?

  • If loss of tissues prevents non-tense primary closure, then preferably resort to either:

    • Skin grafting

    • Local or distant flaps, with or without muscle

    • Combination of muscle flap with skin grafting


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What else ?

  • For proper wound healing:

    • Surrounding tissues must be well vascularized, hence good debridement down to bleeding tissues

    • Adequate oxygenation, hence improve tissue perfusion and oxygen-carrying capacity

    • Moisture; dehydration kills cells and tissues

    • Balanced nutrition with positive nitrogen balance and calories

    • Non-compromised immune system