Open Wound: Therapy

General measures

  • Note: In the primary care of wounds, do not use home remedies such as flour, honey, powder, etc.. These can do more harm than good.
  • Wound treatment should follow the following procedure:
    • In the case of vascular injury, the main focus is to stop the bleeding. Applying pressure to the wound is usually sufficient for this purpose.In cases of life-threatening bleeding in the arms or legs (e.g., after blast or gunshot wounds), a tourniquet is used to stop the bleeding. A tourniquet is a tourniquet system that allows blood flow to be staunched or completely stopped depending on the pressure in the veins and arteries.
    • Inspection (viewing) – to detect deeper injuries of muscles, vessels, nerves, bones.
    • Wound cleaning (preferably with disposable gloves) – remove larger foreign bodies, then rinse the wound with plenty of fluid. A saline solution (NaCl 0.9%) is suitable, but tap water is also sufficient.
    • Disinfection – Especially for heavily soiled wounds. Here, special disinfectants (eg, 1% organoiodine solution) should be used.
    • If there are deeper injuries, these must be supplied first, otherwise debridement (wound toilet, ie removal of dead (necrotic) tissue).
    • Primary wound closure/skin closure (exceptions are bite, scratch, and puncture wounds) should be done in the first 6 hours after injury – taking into account size, depth, concomitant tissue damage, and location:
      • Conventional plasters: to be applied to small, superficial wounds (after cleaning and disinfection). They prevent foreign bodies and germs from entering. After 48 hours, the plaster can be removed. The wound is sufficiently scabbed.
      • Spray plasters: to be applied to small, dry and clean skin injuries. These are sprayed directly onto the wound. It forms a fine and flexible film that is transparent, waterproof and breathable. Once this has dried, it should be re-sprayed two or three more times to reinforce the film. Contraindications: large, deep, infection-prone or already infected wounds.
      • Staple plaster: to be used only for small, minimally gaping wounds whose surroundings are intact (a permanent hold of the staple plaster must be possible). Advantage compared to conventional suture: atraumatic (“non-injuring”) wound closure. Contraindications: very hairy areas, weeping wounds, co-injury to the surrounding tissue.
      • Wound adhesive: to be applied to cleaned, disinfected and no longer bleeding wounds with smooth wound edges. The wound edges are adapted (adjusted) and the adhesive given over. After about 3-4 minutes, the wound is sealed water– and germ-tight. After the healing process, the adhesive comes off spontaneously (by itself). Contraindications: Wounds larger than 5 cm, wounds over motion segments, eg joints.Attention: tissue adhesive in wounds near the eye.
  • At the onset of fever (immediately inform the doctor!).
  • Nicotine restriction (refrain from tobacco consumption) – smoking impairs wound healing.
  • Limited alcohol consumption (men: max. 25 g alcohol per day; women: max. 12 g alcohol per day).
  • Avoidance of environmental pollution:
    • Direct sunlight should not shine on the fresh scar. The UV rays will damage the scar tissue.

Vaccinations

The following vaccination may be required:

  • Check tetanus protection – in case of no or insufficient vaccination protection or in case of doubt: simultaneous vaccination, active and passive (5-12 hours after injury).
  • If necessary, rabies postexposure prophylaxis (PEP).

Regular checkups

  • Regular medical checkups for the purpose of wound control.