Useful Health Tips

Every wound and patient is different so there is no uniform method for the management of acute wounds. However, there are some principles that can guide the decision-making process. Most wounds are suitable for primary closure with sutures while for other wounds, the closure is either delayed or un-attempted.

Any procedure for closing acute wounds must be preceded by cleansing them as infection may disrupt and delay the process of healing the wound. So, it is important to remove all foreign bodies such as dirt, glass, hair and other debris, haematoma and dead or dying tissue that are potential foci for infection.

How to Treat Acute Wounds

Choosing the appropriate closure method

There are a number of factors that need to be considered at the time of choosing the best method of closure. These include details on the history of the injury, the depth of the wound, the likely risk of infection apart from the site, configuration and biomechanical properties of the wound. The patient’s needs in terms of cosmetic appearance and return to full functionality may also determine the choice. To find the best quality medical wound dressing for closing injuries and open wounds, you can shop online.

Sutures

Suturing remains perhaps the oldest and the most common method of wound closure. It requires practice and no nurse should attempt to suture a wound unless they feel they are adequately prepared. The wound must be cleansed and infiltrated with local anaesthetic before inserting the sutures and asepsis must be maintained throughout to minimise the risk of introducing infection. Ensure you have gloves on at this stage.

Adhesive skin-closure strips

They are available in the form of standard (reinforced) strips, elasticated strips and strips that are combined with a transparent dressing. Adhesive skin-closure strips are available in a variety of lengths and widths to suit a range of wounds. The skin surrounding the wound has to be clean and dry before applying the strips are applied. Adhesive strips are useful for superficial and minimum tension wounds. In this, no local anaesthetic is required and patients report good cosmetic results.

Tissue adhesive

First made available in the 1950s, tissue adhesive (cyanoacrylate adhesive or surgical glue) has become increasingly popular as a wound-closure method in emergency settings. It produces good cosmetic results and lesser chances of wound complication. The glue comes in small ampoules which should not be resealed or reused. Tissue adhesive has been found to be an acceptable alternative to sutures in many cases of simple, traumatic lacerations. The glue can be applied by squeezing the opened vial gently and spreading a thin line of the adhesive along the length of the clean, dry wound. Another way is to ‘spot-weld’ the wound by applying a series of dots along its length. The wound needs to be held together for 30 seconds for polymerisation to occur.

Gluing wounds is relatively painless and is quicker than suturing. Moreover, it does not require local anaesthetic so there is no danger of needle-stick injury either. The glue provides a waterproof seal and helps prevent contamination with dirt and bacteria. It is the most cost-effective method. However, there is a slight increase in the rate of wound dehiscence with tissue adhesive compared with standard wound-closure methods. Plus, this method is not suitable over joints and areas of high tension.

Staples

Skin staples have been available in the market for several years now. They are supplied in disposable, single-use sterile packs. To insert staples, the stapler is placed over the carefully apposed edges of a cleaned wound with the edges slightly averted and the handle is squeezed to implant the staple onto the wound. Staples are placed at intervals along the length of the wound. Excessive pressure on the skin should be avoided as it may cause a poor cosmetic result and may make staple removal difficult.

The staples are removed with a special tool once the healing process gets complete. Patient comfort and cosmetic results in stapling are similar to those achieved in sutured wounds. Stapling can be performed without local anaesthetic although some patients may not tolerate stapling without it. Several studies report the usefulness of stapling as a wound-closure method for simple scalp wounds in children because of its low level of tissue reactivity and better resistance to infection.

However, staples are more expensive than sutures, especially when local anaesthetic is required and when removal costs are considered. Stapling requires skill and failing to align the tissue edges correctly may cause scar deformity. So we can conclude that staples are suitable for closing superficial skin layers while sutures may be necessary to heal deeper tissues within a wound.

Care after wound closure

After closure most wounds require a dressing to protect the wound surface and closures against dirt and bacteria, absorb the wound exudates and support the healing process by providing warmth and moisture. Options like 3m micropore tapes help hold the dressing in place. Once the wound has been cleansed, closed and covered, it is important to advice the patient about how to continue the care of his or her wound. The patient should be told when and where to return for removal of sutures or staples, or how and when to remove other forms of wound closure. It is always advisable to inform patients of the signs of infection and where to go if they are concerned about their wound.