Skip to main content
Top
Published in: International Journal of Emergency Medicine 4/2010

Open Access 01-12-2010 | Review Article

Acute wound management: revisiting the approach to assessment, irrigation, and closure considerations

Authors: Bret A. Nicks, Elizabeth A. Ayello, Kevin Woo, Diane Nitzki-George, R. Gary Sibbald

Published in: International Journal of Emergency Medicine | Issue 4/2010

Login to get access

Abstract

Background

As millions of emergency department (ED) visits each year include wound care, emergency care providers must remain experts in acute wound management. The variety of acute wounds presenting to the ED challenge the physician to select the most appropriate management to facilitate healing. A complete wound history along with anatomic and specific medical considerations for each patient provides the basis of decision making for wound management. It is essential to apply an evidence‐based approach and consider each wound individually in order to create the optimal conditions for wound healing.

Aims

A comprehensive evidence‐based approach to acute wound management is an essential skill set for any emergency physician or acute care practitioner. This review provides an overview of current evidence and addresses frequent pitfalls.

Methods

A systematic review of the literature for acute wound management was performed.

Results

A structured MEDLINE search was performed regarding acute wound management including established wound care guidelines. The data obtained provided the framework for evidence‐based recommendations and current best practices for wound care.

Conclusion

Acute wound management varies based on the wound location and characteristics. No single approach can be applied to all wounds; however, a systematic approach to acute wound care integrated with current best practices provides the framework for exceptional wound management.
Literature
1.
go back to reference Pitts SR, Niska RW, Xu J, Burt CW (2008) National hospital ambulatory medical care survey: 2006 Emergency department summary. National Health Care Statistics 6(7):1–40 Pitts SR, Niska RW, Xu J, Burt CW (2008) National hospital ambulatory medical care survey: 2006 Emergency department summary. National Health Care Statistics 6(7):1–40
2.
go back to reference Hollander JE, Singer AJ, Valentine SM, Shofer FS (2001) Risk factors for infection in patients with traumatic lacerations. Acad Emerg Med 8(7):716–720PubMedCrossRef Hollander JE, Singer AJ, Valentine SM, Shofer FS (2001) Risk factors for infection in patients with traumatic lacerations. Acad Emerg Med 8(7):716–720PubMedCrossRef
3.
go back to reference Singer AJ, Dagum AB (2008) Current management of acute cutaneous wounds. N Engl J Med 359(10):1037–1046PubMedCrossRef Singer AJ, Dagum AB (2008) Current management of acute cutaneous wounds. N Engl J Med 359(10):1037–1046PubMedCrossRef
4.
go back to reference Barbul A (2005) Wound healing. In: Brunicardi FC, Andersen DK, Billiar TR et al (eds) Schwartz’s principles of surgery, Eighthth edn. The McGraw-Hill Companies, Inc, Columbus, pp 165–182 Barbul A (2005) Wound healing. In: Brunicardi FC, Andersen DK, Billiar TR et al (eds) Schwartz’s principles of surgery, Eighthth edn. The McGraw-Hill Companies, Inc, Columbus, pp 165–182
5.
go back to reference Woo K, Ayello EA, Sibbald RG (2007) The edge effect: current therapeutic options to advance the wound edge. Adv Skin Wound Care 20(2):99–117PubMedCrossRef Woo K, Ayello EA, Sibbald RG (2007) The edge effect: current therapeutic options to advance the wound edge. Adv Skin Wound Care 20(2):99–117PubMedCrossRef
6.
go back to reference Percival NJ (2002) Classification of wounds and their management. Surgery 20(5):114–117 Percival NJ (2002) Classification of wounds and their management. Surgery 20(5):114–117
7.
go back to reference Berk WA, Welch RD, Bock BF (1992) Controversial issues in clinical management of the simple wound. Ann Emerg Med 21(1):72–80PubMedCrossRef Berk WA, Welch RD, Bock BF (1992) Controversial issues in clinical management of the simple wound. Ann Emerg Med 21(1):72–80PubMedCrossRef
8.
go back to reference Chisholm CD (1992) Wound evaluation and cleansing. Emerg Med Clin North Am 10(4):665–672PubMed Chisholm CD (1992) Wound evaluation and cleansing. Emerg Med Clin North Am 10(4):665–672PubMed
9.
go back to reference Lammers RL, Hudson DL, Seaman ME (2003) Prediction of traumatic wound infection with a neural network-derived decision model. Am J Emerg Med 21(1):1–7PubMedCrossRef Lammers RL, Hudson DL, Seaman ME (2003) Prediction of traumatic wound infection with a neural network-derived decision model. Am J Emerg Med 21(1):1–7PubMedCrossRef
10.
go back to reference Frank M, Schmucker U, Hinz P, Zach A, Ekkernkamp A, Matthes G (2008) Not another 4th of July report: uncommon blast injuries to the hand. Emerg Med J 25(2):93–97PubMedCrossRef Frank M, Schmucker U, Hinz P, Zach A, Ekkernkamp A, Matthes G (2008) Not another 4th of July report: uncommon blast injuries to the hand. Emerg Med J 25(2):93–97PubMedCrossRef
11.
go back to reference Zempsky WT, Cravero JP (2004) Relief of pain and anxiety in pediatric patients in emergency medical systems. Pediatrics 114(5):1348–1356PubMedCrossRef Zempsky WT, Cravero JP (2004) Relief of pain and anxiety in pediatric patients in emergency medical systems. Pediatrics 114(5):1348–1356PubMedCrossRef
12.
go back to reference Bonadio WA (1996) Safe and effective method for application of tetracaine, adrenaline, and cocaine to oral lacerations. Ann Emerg Med 28(4):396–398PubMedCrossRef Bonadio WA (1996) Safe and effective method for application of tetracaine, adrenaline, and cocaine to oral lacerations. Ann Emerg Med 28(4):396–398PubMedCrossRef
13.
go back to reference Ernst AA, Marvez-Valls E, Nick TG, Mills T, Minvielle L, Houry D (1997) Topical lidocaine adrenaline tetracaine (LAT gel) versus injectable buffered lidocaine for local anesthesia in laceration repair. West J Med 167(2):79–81PubMedPubMedCentral Ernst AA, Marvez-Valls E, Nick TG, Mills T, Minvielle L, Houry D (1997) Topical lidocaine adrenaline tetracaine (LAT gel) versus injectable buffered lidocaine for local anesthesia in laceration repair. West J Med 167(2):79–81PubMedPubMedCentral
14.
go back to reference Railan D, Alster TS (2007) Use of topical lidocaine for cosmetic dermatologic procedures. J Drugs Dermatol 6(11):1104–1108PubMed Railan D, Alster TS (2007) Use of topical lidocaine for cosmetic dermatologic procedures. J Drugs Dermatol 6(11):1104–1108PubMed
15.
go back to reference Kundu S, Achar S (2002) Principles of office anesthesia: part II. Topical anesthesia. Am Fam Physician 66(1):99–102PubMed Kundu S, Achar S (2002) Principles of office anesthesia: part II. Topical anesthesia. Am Fam Physician 66(1):99–102PubMed
16.
go back to reference Scarfone RJ, Jasani M, Gracely EJ (1998) Pain of local anesthetics: Rate of administration and buffering. Ann Emerg Med 31(1):36–40PubMedCrossRef Scarfone RJ, Jasani M, Gracely EJ (1998) Pain of local anesthetics: Rate of administration and buffering. Ann Emerg Med 31(1):36–40PubMedCrossRef
17.
go back to reference Brogan GX, Singer AJ, Valentine SM et al (1997) Comparison of wound infection rates using plain versus buffered lidocaine for anesthesia of traumatic wounds. Am J Emerg Med 15:25–28PubMedCrossRef Brogan GX, Singer AJ, Valentine SM et al (1997) Comparison of wound infection rates using plain versus buffered lidocaine for anesthesia of traumatic wounds. Am J Emerg Med 15:25–28PubMedCrossRef
18.
go back to reference Thyssen JP, Menné T, Elberling J, Plaschke P, Johansen JD (2008) Hypersensitivity to local anaesthetics–update and proposal of evaluation algorithm. Contact Dermat 59(2):69–78CrossRef Thyssen JP, Menné T, Elberling J, Plaschke P, Johansen JD (2008) Hypersensitivity to local anaesthetics–update and proposal of evaluation algorithm. Contact Dermat 59(2):69–78CrossRef
19.
go back to reference Daya MR, Burton BT, Schleiss MR, DiLiberti JH (1988) Recurrent seizures following mucosal application of TAC. Ann Emerg Med 17(6):646–648PubMedCrossRef Daya MR, Burton BT, Schleiss MR, DiLiberti JH (1988) Recurrent seizures following mucosal application of TAC. Ann Emerg Med 17(6):646–648PubMedCrossRef
20.
21.
go back to reference Howell JM, Chisholm CD (1992) Outpatient wound preparation and care: a national survey. Ann Emerg Med 21(8):976–981PubMedCrossRef Howell JM, Chisholm CD (1992) Outpatient wound preparation and care: a national survey. Ann Emerg Med 21(8):976–981PubMedCrossRef
22.
go back to reference Pfaff JA, Moore GP (2007) Reducing risk in emergency department wound management. Emerg Med Clin N Am 25:189–201CrossRef Pfaff JA, Moore GP (2007) Reducing risk in emergency department wound management. Emerg Med Clin N Am 25:189–201CrossRef
23.
go back to reference Singer AJ, Hollander JE, Subramanian S, Malhotra AK, Villez PA (1994) Pressure dynamics of various irrigation techniques commonly used in the emergency department. Ann Emerg Med 24(1):36–40PubMedCrossRef Singer AJ, Hollander JE, Subramanian S, Malhotra AK, Villez PA (1994) Pressure dynamics of various irrigation techniques commonly used in the emergency department. Ann Emerg Med 24(1):36–40PubMedCrossRef
24.
go back to reference Longmire AW, Broom LA, Burch J (1987) Wound infection following high-pressure syringe and needle irrigation. Am J Emerg Med 5(2):179–81PubMedCrossRef Longmire AW, Broom LA, Burch J (1987) Wound infection following high-pressure syringe and needle irrigation. Am J Emerg Med 5(2):179–81PubMedCrossRef
25.
go back to reference Rodeheaver GT, Ratliff (2008) Wound cleansing, wound irrigation, wound disinfection. In: Krasner D, Rodeheaver G, Sibbald RG (eds) Chronic wound care, Chapter 34. HMP Communications, Malvern Rodeheaver GT, Ratliff (2008) Wound cleansing, wound irrigation, wound disinfection. In: Krasner D, Rodeheaver G, Sibbald RG (eds) Chronic wound care, Chapter 34. HMP Communications, Malvern
26.
go back to reference Chisholm CD, Cordell WH, Rogers K, Woods JR (1992) Comparison of a new pressurized saline canister versus syringe irrigation for laceration cleansing in the emergency department. Ann Emerg Med 21(11):1364–1367PubMedCrossRef Chisholm CD, Cordell WH, Rogers K, Woods JR (1992) Comparison of a new pressurized saline canister versus syringe irrigation for laceration cleansing in the emergency department. Ann Emerg Med 21(11):1364–1367PubMedCrossRef
27.
go back to reference Grotz MR, Allami MK, Harwood P, Pape HC, Krettek C, Giannoudis PV (2005) Open pelvic fractures: epidemiology, current concepts of management and outcome. Injury 36(1):1–13PubMedCrossRef Grotz MR, Allami MK, Harwood P, Pape HC, Krettek C, Giannoudis PV (2005) Open pelvic fractures: epidemiology, current concepts of management and outcome. Injury 36(1):1–13PubMedCrossRef
28.
go back to reference Fernandez R, Griffiths R (2008) Water for wound cleansing. Cochrane Database Syst Rev 23(1):CD003861 Fernandez R, Griffiths R (2008) Water for wound cleansing. Cochrane Database Syst Rev 23(1):CD003861
29.
go back to reference Khan MN, Naqvi AH (2006) Antiseptics, iodine, povidone iodine and traumatic wound cleansing. J Tissue Viability 16(4):6–10PubMedCrossRef Khan MN, Naqvi AH (2006) Antiseptics, iodine, povidone iodine and traumatic wound cleansing. J Tissue Viability 16(4):6–10PubMedCrossRef
30.
31.
34.
go back to reference Eron LJ (1999) Targeting lurking pathogens in acute traumatic and chronic wounds. J Emerg Med 17(1):189–195PubMedCrossRef Eron LJ (1999) Targeting lurking pathogens in acute traumatic and chronic wounds. J Emerg Med 17(1):189–195PubMedCrossRef
35.
go back to reference Hankin A, Everett WW (2007) Are antibiotics necessary after incision and drainage of a cutaneous abscess? Ann Emerg Med 50(1):49–51PubMedCrossRef Hankin A, Everett WW (2007) Are antibiotics necessary after incision and drainage of a cutaneous abscess? Ann Emerg Med 50(1):49–51PubMedCrossRef
36.
go back to reference Edlich RF, Rodeheaver GT, Morgan RF et al (1988) Principles of emergency wound management. Ann Emerg Med 17:1284–1302PubMedCrossRef Edlich RF, Rodeheaver GT, Morgan RF et al (1988) Principles of emergency wound management. Ann Emerg Med 17:1284–1302PubMedCrossRef
37.
go back to reference Ichikawa S, Ishihara M, Okazaki T et al (2007) Prospective study of antibiotic protocols for managing surgical site infections in children. J Pediatr Surg 42(6):1002–1007PubMedCrossRef Ichikawa S, Ishihara M, Okazaki T et al (2007) Prospective study of antibiotic protocols for managing surgical site infections in children. J Pediatr Surg 42(6):1002–1007PubMedCrossRef
38.
go back to reference Farion KJ, Osmond MH, Hartling L et al (2003) Tissue adhesives for traumatic lacerations: a systematic review of randomized controlled trials. Acad Emerg Med 10(2):110–118PubMedCrossRef Farion KJ, Osmond MH, Hartling L et al (2003) Tissue adhesives for traumatic lacerations: a systematic review of randomized controlled trials. Acad Emerg Med 10(2):110–118PubMedCrossRef
39.
go back to reference Lloyd JD, Marque MJ, Kacprowicz RF (2007) Closure Techniques. Emerg Med Clin North Am 25(1):73–81PubMedCrossRef Lloyd JD, Marque MJ, Kacprowicz RF (2007) Closure Techniques. Emerg Med Clin North Am 25(1):73–81PubMedCrossRef
40.
go back to reference Fonder MA, Mamelak AJ, Lazarus GS, Chanmugam A (2007) Occlusive wound dressings in emergency medicine and acute care. Emerg Med Clin North Am 25(1):235–242PubMedCrossRef Fonder MA, Mamelak AJ, Lazarus GS, Chanmugam A (2007) Occlusive wound dressings in emergency medicine and acute care. Emerg Med Clin North Am 25(1):235–242PubMedCrossRef
41.
go back to reference Davidson JM, Breyer MD (2003) Inflammatory modulation and wound repair. J Invest Dermatol 120(5):xi–xiiPubMedCrossRef Davidson JM, Breyer MD (2003) Inflammatory modulation and wound repair. J Invest Dermatol 120(5):xi–xiiPubMedCrossRef
42.
go back to reference Sibbald RG, Orsted H, Schultz GS, Coutts P, Keast D (2003) International Wound Bed Preparation Advisory Board, Canadian Chronic Wound Advisory Board. Preparing the wound bed 2003: focus on infection and inflammation. Ostomy/Wound Manage 49(11):23–51 Sibbald RG, Orsted H, Schultz GS, Coutts P, Keast D (2003) International Wound Bed Preparation Advisory Board, Canadian Chronic Wound Advisory Board. Preparing the wound bed 2003: focus on infection and inflammation. Ostomy/Wound Manage 49(11):23–51
43.
go back to reference Sibbald RG, Orsted HL, Coutts PM, Keast DL (2007) Best practice recommendations for preparing the wound bed: update 2006. Adv Skin Wound Care 20:390–405PubMedCrossRef Sibbald RG, Orsted HL, Coutts PM, Keast DL (2007) Best practice recommendations for preparing the wound bed: update 2006. Adv Skin Wound Care 20:390–405PubMedCrossRef
44.
go back to reference Sibbald RG, Williamson D, Orsted HL et al (2000) Preparing the wound bed: debridement, bacterial balance and moisture balance. Ostomy/Wound Manage 46(11):14–35 Sibbald RG, Williamson D, Orsted HL et al (2000) Preparing the wound bed: debridement, bacterial balance and moisture balance. Ostomy/Wound Manage 46(11):14–35
45.
go back to reference Stone S, Carter WA (2004) Wound preparation. In: Tintinalli JE, Kelen GD, Stapczynski JS, Ma OJ, Clin DM (eds) Tintinalli’s emergency medicine. The McGram-Hill Companies, Inc, New York, pp 284–287 Stone S, Carter WA (2004) Wound preparation. In: Tintinalli JE, Kelen GD, Stapczynski JS, Ma OJ, Clin DM (eds) Tintinalli’s emergency medicine. The McGram-Hill Companies, Inc, New York, pp 284–287
Metadata
Title
Acute wound management: revisiting the approach to assessment, irrigation, and closure considerations
Authors
Bret A. Nicks
Elizabeth A. Ayello
Kevin Woo
Diane Nitzki-George
R. Gary Sibbald
Publication date
01-12-2010
Publisher
Springer Berlin Heidelberg
Published in
International Journal of Emergency Medicine / Issue 4/2010
Print ISSN: 1865-1372
Electronic ISSN: 1865-1380
DOI
https://doi.org/10.1007/s12245-010-0217-5

Other articles of this Issue 4/2010

International Journal of Emergency Medicine 4/2010 Go to the issue

Clinical Images

Omental cake