Cutaneous wounds

11.8 million wounds treated in emergency departments in the U.S. on 2005.

More than half a million burns treated annually.

More than 7.3 million lacerations treated annually.

Wounds related to cuts or piercings account for approximately 2 million outpatient visits each year.

Animal bites account for approximately 4.7 million visits annually.

Skin tear lesions account for approximately 1.5 million cases of cutaneous wounds per year.

Goals of management: rapid healing, preservation of function and aesthetics are best accomplished by preventing infection, and further injury along with providing an optimal environment for would healing (Singer A).

All wounds should be cleaned with water or saline and the use of high pressure irrigation for contaminated wounds is suggested.

Tetanus immunization status should be questioned and appropriately managed for such wounds.

The acceleration of wound healing is promoted by a moist environment.

Providing a moist environment prevents cellular dehydration, and stimulates collagen synthesis and angiogenesis.

A moist environment cuts the risk of infection and pain.

Covering wounds with topical antibacterial agents or applying an occlusive dressing prevents loss of fluids.

Traumatic wounds treated with topical antibiotics associated with a decrease in infections rates.

Wounds caused by elective surgery treated with topical antibiotics do not have lowered infection rates (Smack).

Occlusive dressing reduce wound infection rate.

Cyanoacrylate based liquid bandages are effective for simple and clean wounds.

Dressings for wounds are variable and related to the type of wound, its size, depth, location, degree of contamination and extent of exudation.

Occlusive dressings are more expensive than other types of dressings.

Occlusive dressings are associated with less pain and are more convenient than other dressings.

Occlusive dressings associated with less pain than other types of dressings.

Occlusive dressings may speed healing.

In general, occlusive dressings need to be changed less often.

Wet dressings that lead to maceration and bacterial proliferation should be avoided.

Systemic prophylactic antibiotics are generally not provided.

Abrasions that are superficial should be irrigated, foreign bodies removed and topical antibiotic or occlusive dressing is placed.

Abrasions that are deep and extend below the dermis, and especially if large, and those that have not healed in 2 weeks may require grafting and/or a plastic surgeon.

When particles become imbedded into the injured skin and they are not removed is can lead to posttraumatic tattooing, the presence of abnormal pigmentation.

To prevent posttraumatic tattooing removal of all particle with scrub brushes is recommended.

Removal of particles within 24 hours of imbedding associated with the best cosmetic results.

Low tension lacerations may be treated with cyanoacrylate topical skin adhesives and adhesives and surgical tapes in place of sutures.

Skin tears refers to the presence of fragile skin seen mainly in elder patients and those exposed to long-term corticosteroids.

Skin tears without tissue loss, category I, wound edges can be approximated with surgical tape and dressed with a non adherent dressing.

Category I tears treated as above result in a 66% healing rate, compared to thin-film dressings with a 33% healing rate.

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