Wound Care Guidelines

Introduction to Wound Care

The goal of wound cleansing is to physically remove foreign material, cellular debris, surface bacteria, and body fluids, as stated by the World Journal of Emergency Surgery 1
Ensure tetanus immunization status is current and administer tetanus toxoid if outdated or unknown, as recommended by the Infectious Diseases Society of America 2

Apply a thin non-adherent contact layer directly to the wound surface (e.g., a non-stick dressing) to prevent the dressing from sticking to the wound and causing damage during changes, as recommended by the British Journal of Dermatology guidelines 3
For dry wounds, consider applying a greasy emollient such as a mixture of white soft paraffin and liquid paraffin to promote moisture retention, according to the British Journal of Dermatology guidelines 3
Irrigate the wound with sterile saline or clean potable tap water until all visible debris is removed, using sufficient volume (100-1000 mL) and adequate pressure for irrigation, as recommended by the American Heart Association and the World Journal of Emergency Surgery 4, 5, 6, 1
Avoid additives such as soap or antiseptics in irrigation solutions, as they provide no additional benefit and may impair healing, according to the American Academy of Orthopaedic Surgeons 7
Choose dressing options according to wound size, depth, and nature, such as:
Consider negative pressure wound therapy (NPWT) for effective management of excess fluid, as recommended by the World Society of Emergency Surgery 9
Consider removable rigid dressings (RRDs) which have been shown to provide better protection from external trauma, facilitate wound closure in cases of dehiscence, and allow for wound inspection and treatment as needed, as reported by the Association of Academic Physiatrists 10

Monitor for signs of infection, which include redness, swelling, or warmth around the wound, increasing pain or tenderness, foul-smelling drainage or purulence, and fever or systemic symptoms, as advised by the American Heart Association 4
Consider antibiotic prophylaxis for high-risk wounds (bites, deep wounds, contaminated wounds), according to the World Society of Emergency Surgery 9
Administer antibiotic prophylaxis as soon as possible, with first-line options including amoxicillin-clavulanate or cephalosporins, as recommended by the American Academy of Orthopaedic Surgeons and the American Society of Anesthesiologists 11, 7
Maintain good personal hygiene with regular hand washing, as recommended by the Infectious Diseases Society of America 12

Apply ice for pain relief for no more than 20 minutes at a time with breaks between applications, as recommended by the American Heart Association 6
Use topical anesthetic such as LET (lidocaine, epinephrine, tetracaine) directly to the wound, with a dose of 3 mL for children >17 kg and 0.175 mL/kg in children <17 kg, allowing 10-20 minutes for full effect or until wound edges appear blanched, as recommended by the American Academy of Pediatrics 13

Regular follow-up is necessary to assess healing progress, monitor for complications, and adjust treatment as needed, with the British Journal of Dermatology recommending careful assessment and management 14
Follow-up should be arranged for suture removal or wound check within 10-14 days, according to the American College of Surgeons 15
Arrange for wound check within 24-48 hours to ensure proper healing, and monitor for signs of infection and watch for wound dehiscence, which may require additional intervention, as part of standard wound care 16
Seek immediate medical attention if the wound becomes increasingly red, swollen, or painful, purulent drainage develops, or fever or other systemic symptoms occur, as recommended by the American Heart Association 4
Elevate the injured area to reduce swelling and accelerate healing, as recommended by the Infectious Diseases Society of America 2