Primary wound care means acute wound care—managing a wound the first time it is presented to a healthcare professional.
- Basic plan
- Stabilize the patient
- Take a history
Check for significant neural or vascular damage-wound Care
Caring for a wound will cause the patient pain; nevertheless, before giving an anesthetic you must check to see if major nerves or blood vessels have been injured. Test the injured area and the more distal areas of the body:
- Is there full sensation?
- Can all muscles be moved?
- Is there adequate circulation?
If you suspect major neural or vascular problems, call in a surgical specialist..
- Cleanse the wound
- Close the wound
- Cover the wound
Medications and care instructions
Immediate direct closure
(by suturing, stapling, gluing, or taping) is called healing by first intention or primary wound repair
Allows the wound to contract and to re-epithelialize on its own. This is called healing by second intention or secondary wound repair.
Delayed direct closure
Lets the wound remain open initially and later closes it with sutures or staples. This two-part closure plan is called healing by third intention or tertiary wound repair. Delayed direct closure is used for highly contaminated wounds, which may need repeated debridement or may need to be treated with antibiotics before being closed.
Ointments help to keep wounds moist, and they reduce the crust that can form on the surface. Ointments also keep dressings from sticking to the wound. On the other hand, ointments will dissolve tissue glues, so ointments should not be put on wounds that have been closed with adhesives.
Dressings keep a healing wound warm and protected. They also keep the wound from drying out, while at the same time absorbing excess fluid and exudate, both of which can slow healing. On the other hand, once a wound is infected, a thick dressing will encourage bacterial growth; therefore, thick or impermeable dressings are not put over infected wounds.
A bandage—an outer layer of dressing—is used to mechanically protect a wound. Bandages help hold the wound closure in place and can reduce tension across the healing scar.
Although systemic antibiotics are often given to patients with acute wounds, most clinicians argue that antibiotics should only be given with a specific purpose in mind.
For Suture Removal
The proper time to remove wound sutures is decided case by case. A general timetable is:
- Face at 3 to 5 days
- Scalp or trunk at 7 to 10 days
- Arms or legs at 7 to 14 days
- Joints at 14 days
Staples can usually be removed somewhat earlier than sutures.
- The wound area may tingle, feel strange, or itch. By pressing on the skin or by lightly rubbing it, the feelings can usually be toned down. These feelings may show up for many months, but they should be gone within a year.
- Deeper wounds may have injured some sensory nerves, so the patient may have numbness or lessened sensation distal to the wound. This problem usually improves on its own within a year.
- All wounds, no matter how artfully repaired, leave a scar. Typical scars get darker and redder before they eventually fade. It can be a year or more before they reach their final appearance.
- Currently, there is not enough scientific support to recommend any of the creams or lotions that claim to limit scar formation.
Home Care Instructions
Write down a set of instructions telling the patient how to care for the healing wound.
Check for Signs of Infection
SIGNS AND SYMPTOMS OF AN INFECTED WOUND
- Pus or yellow, greenish, or thick whitish fluid in the wound
- Increased redness in the wound
- Redness radiating out into the skin around the wound
- Red lines progressing up an extremity
- Increasing pain or tenderness (note: uninfected sutures do not cause pain)
- Wound getting warmer than normal skin
Elevate the Wound
Elevating the injured area will minimize swelling, reduce any throbbing pain, and speed up healing.
Protect the Wound
Tell the patient
- When it is healing normally, most wounds that have been directly closed will become impermeable to bacteria and water within two days.
- The edges of a directly closed healing wound are held together only weakly for the first 5 days; therefore, be especially careful with the wound for the first week. The new scar will then strengthen rapidly over the next month.
- A wound that has been splinted should remain immobilized until the sutures or staples have been removed.
- There is no general reason that most healing wounds need to be kept dry. After day 2, patients with sutured or stapled wounds can bathe and shower. Swimming in uncontaminated water is usually safe after the wound begins to strengthen (i.e., after about 5 days).
Cleanse the Wound
You will probably send all wounds home with a protective dressing. Minor wounds and many sutured or stapled wounds will not need these coverings after a day. The coverings can then be discarded and the wound left uncovered.
In most cases, you can tell your patient that, when treating the wound, cleanliness is needed but sterility is not.
A sutured or stapled wound without a dressing can be cleansed gently twice a day with soap and water, beginning 1 day after the suturing or stapling. A major goal of these washings is to remove the crusting that develops from the wound exudate. Such a wound can remain uncovered from day 2 on.
When the wound is inside the mouth, have the patient rinse the injured area at least three times daily with warm salt water.
For wounds that need continued covering, for the first 2 days, the patient should keep the wound dressing clean and dry, and change the dressing only if it gets dirty or becomes saturated with exudate. Beginning on day 2, the wound can be cleansed and the dressing changed daily. After a week, most wounds can be left uncovered.
To change a dressing….
- Gently remove the dressings.
- Wash the wound with soap and tap water (Anglen, 2005)
- Pat the wound dry.
- Apply a moistening ointment, such as a triple antibiotic ointment.
- Put on a fresh dressing.
Medicines to Avoid
In the early healing stages, patients should not take aspirin, because it decreases the strength of the scar and it increases the risk of developing a hematoma. Patients should also not drink alcohol during the hours after the initial wound treatment.
For serious, infected, and nonhealing wounds, a professional should handle the secondary care.
Culture and Biopsy
Skin grafts, even when they are not permanent, can help some recalcitrant wounds to heal. In the near future, artificial skin, laboratory-grown skin, and skin substitutes will be more commonly available to cover and protect wounds that are not able to epithelialize themselves