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Provider Prepared’s Weekly Pearl of Wound Wisdom #16 Leg vs Tiller!

Provider Prepared’s Weekly Pearl of Wound Wisdom #16 Leg vs Tiller! 0

A 72 year old male with diabetes presents to the Emergency Department for management of a lower leg wound. The large, complex laceration was created about 30 hours prior while rototilling his garden. The rototiller skipped off of a rock causing the tiller tines to impact his lower leg. The wound was heavily contaminated with dirt that he rinsed out in a shower last night.

Delayed primary closure is the type of closure that should be used for wounds that are older than 24 hours that have had extensive contamination and were insufficiently cleansed. Additionally, wounds older than 24 hours associated with diabetes, advanced age, smoking, renal impairment, poor nutrition, obesity, and chronic steroid therapy should have delayed primary closure considered as their means of management.
Brancato, JO et al. Minor wound preparation and irrigation. UpToDate December 2017.

This 72 year old patient had his wound thoroughly cleansed and dressed in a sterile fashion. He was started on 10 days of cephalexin and five days later returned for wound closure. The wound margins were debrided and then closed with horizontal mattress sutures. 14 days later, sutures were removed from a well healed wound with no complications.

Provider Prepared has all your wound care needs available now! Visit us for the peace of mind and integrity of being prepared at home and on the go.

Provider Prepared
Nathan Whittaker, MD

  • Brandon Durfee
Provider Prepared’s Weekly Pearl of Wound Wisdom #15 This happened how long ago?

Provider Prepared’s Weekly Pearl of Wound Wisdom #15 This happened how long ago? 0

Making the decision to perform primary closure, healing by secondary intention, or delayed primary closure is primarily based upon clinical judgment. Absolute contraindications to wound closure are redness, warmth, swelling, and excessive pain. In the absence of these findings, wound closure is appropriate.

Wounds that are generally appropriate for healing by secondary intention are: deep stabbing puncture wounds that cannot be adequately irrigated, heavily contaminated wounds that cannot be appropriately cleaned, small noncosmetic animal bites, abscess cavities that have undergone incision and drainage. Delay in presentation for wound care is also an indication for secondary intention.

Wounds that are on the trunk or proximal extremity that have been caused by clean, sharp objects can be repaired by primary closure 12 to 18 hours from the time of injury. Similar wounds on the face and neck can be repaired within 24 hours of the injury. For older wounds do not proceed with primary closure.

Brancato, JO et al. Minor wound preparation and irrigation. UpToDate December 2017.

Visit Provider Prepared to get the peace of mind that comes with being prepared for all your wound care needs at home!

Provider Prepared
Nathan Whittaker, MD

  • Brandon Durfee
Provider Prepared’s Weekly Pearl of Wound Wisdom #14 Immobilize it to move it!

Provider Prepared’s Weekly Pearl of Wound Wisdom #14 Immobilize it to move it! 0

It is recommended that injuries suspected to be fractures be splinted prior to the patient being transported for medical care.

Prior to splinting expose the entire extremity, clean and repair any skin lesions, then apply appropriate wound dressings before placing the splint. Also take into consideration the patient’s ability to remove clothing with the splint in place, remove clothing as appropriate.

When appropriate, immobilize the joints above and below a fracture. Place extra padding at the fracture site. For dislocated joints, immobilize bones above and below the dislocated joint as appropriate.

Stacciolini, AN et al. Basic techniques for splinting of musculoskeletal injuries. UpToDate May 2017.

Be prepared for your splinting needs with Sam Splint available from Provider Prepared!

Provider Prepared
Nathan Whittaker, MD
  • Brandon Durfee
Provider Prepared’s Weekly Pearl of Wound Wisdom #13 Staples of Life

Provider Prepared’s Weekly Pearl of Wound Wisdom #13 Staples of Life 0

For many minor wounds that are linear with sharp edges, and have dermal involvement only, skin staples are an acceptable alternative to sutures.
Lacerations in the scalp, trunk, and extremities are well managed with staples. Lacerations upon the face, neck, hands and feet should not be closed with staples.

Scalp lacerations in particular, are well suited for closure with staples. Randomized trials have shown that scalp wounds closed with staples have similar infection rates, healing time,and cosmesis compared to sutures.

Lipsett, SU, et al. Closure of minor skin wounds with staples. UpToDate Sep 2017.

Be prepared with the convenience of a skin staple kit from Provider Prepared!

Provider Prepared
Nathan Whittaker, MD
  • Brandon Durfee
Provider Prepared’s Weekly Pearl of Wound Wisdom #12 Lessons in Ligature

Provider Prepared’s Weekly Pearl of Wound Wisdom #12 Lessons in Ligature 0

Wounds that have damaged large blood vessels (>2mm) with active bleeding should be carefully managed individually. Placement of a ligature stitch with fine absorbable suture is the preferred method of hemostasis.

Nerves frequently course through tissues with blood vessels. All clamping and ligation of blood vessels should be done under direct visualization to avoid nerve damage.

Using hemostats, the bleeding end of the vessel is clamped, the hemostat is lifted to expose the vessel. An absorbable 5-0 or 6-0 suture is then passed around the hemostat and a knot tied around the vessel past the end of the hemostat. The hemostat is removed once the suture is anchored. Three knots are used to secure the ligature stitch.
Roberts, JA et al. Clinical Procedures in Emergency Medicine 2010. 573

Be prepared for all your ligature wound management needs with a laceration repair kit from Provider Prepared!

Provider Prepared
Nathan Whittaker, MD

  • Brandon Durfee
Provider Prepared’s Weekly Pearl of Wound Wisdom #11 All bleeding stops eventually!

Provider Prepared’s Weekly Pearl of Wound Wisdom #11 All bleeding stops eventually! 0

Achieving hemostasis is an essential part of wound care. Active bleeding obscures proper wound exploration, and complicates the closure of the wound. Ongoing bleeding into a closed wound leads to hematoma formation between tissue layers. The presence of hematoma separates tissue edges, leading to impaired wound healing. Hematoma also provides a breeding ground for infection.

Application of direct pressure to the site of bleeding is the first practical step in bleeding management. If bleeding persists, a compression dressing can be constructed using multiple gauze sponges topped with an elastic bandage to create holding pressure. For the majority of simple wounds approximation of wound edges with sutures, followed by placement of a compression dressing, will control bleeding.
Roberts, JA et al. Clinical Procedures in Emergency Medicine 2010. 572-574

Have peace of mind knowing you are prepared to stop the bleeding with a laceration repair kit from Provider Prepared!

Provider Prepared
Nathan Whittaker, MD
  • Brandon Durfee