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Provider Prepared’s Weekly Pearl of Wound Wisdom #1 - Dilution is the Solution to Pollution

Provider Prepared’s Weekly Pearl of Wound Wisdom #1 - Dilution is the Solution to Pollution 0

The first step in all good wound management is proper cleansing and preparation of the wound. A thorough examination of the wound looking for debris and foreign material must be completed. Remove large pieces of debris under direct visualization, taking care not to create more trauma. Avoid getting caught in the quixotic venture of picking out every spec of sand or dirt. Small debris is easily irrigated from the wound.

Traditionally sterile saline is the fluid of choice for wound irrigation. We now have literature that shows no significant difference in cosmesis or infection rate with tap water. Studies have shown that the more important factor improving these is volume; more volume is better.  After irrigation is completed, reevaluate the wound ensuring it is clean from all foreign material. Provider Prepared has you set for irrigation success with pressurized sterile saline in our LACERATION REPAIR KITSClick the link to get yours today!

Weiss, EA et al. BMJ Open/ 2013 Jan 16:3(1). PMID 23325896


Provider Prepared

Dr. Nate Whittaker, MD

  • Dr. Nate Whittaker, MD Emergency Medicine Specialist
Essential Steps in Laceration Repair

Essential Steps in Laceration Repair 0

Open wounds can occur in a split second, regardless of where you are or what you happen to be doing. It is important to understand and follow appropriate procedures for finger laceration repair and other wound care, in order to avoid infection and promote proper healing.

Open Wound Types

Though it is common to hear wounds that require suturing referred to as “cuts, lacerations, tears” etc., this is not completely accurate. Open wounds and their particular causes can be found in greater detail below.

  • Lacerations: Tear-like wounds that are irregular in nature, typically the result of blunt-force trauma. This term is commonly used incorrectly to describe what is actually an incision wound.
  • Incisions/incised wounds: A cut in the skin and other tissue from objects with sharp edges, such as glass, a knife, or a razor.
  • Abrasions: A wound, superficial in nature, in which the topmost skin layer (epidermis) has been grazed or scraped off, generally the result of a fall on a rough surface.
  • Punctures: A wound to the skin or other tissue from an object like a nail or needle puncturing through the skin.
  • Penetration wounds: The result of an object, like a knife, entering and exiting the skin.

 Overview of Laceration Repair

A laceration is a type of wound consisting of skin, tissue, or muscle that has been torn open. These wounds may range from shallow, short, and narrow, to deep, long, and wide. Some lacerations are so minor in nature (minimal damage to tissues, no bleeding, etc.) that they never need medical attention, though ointment and bandaging may be applied for comfort and efficient healing. For the most part, however, lacerations will need to be repaired with appropriate medical care and procedures.

In general, lacerations are caused by something hitting the skin, or vice versa, with a great deal of force behind it. This can occur when a child accidentally runs into a door frame, or if you slam your finger in the car door. You may then require finger laceration repair, which would consist of proper wound preparation, cleansing, and closure.

Laceration Repair: Wound Cleansing

An essential element of laceration repair is the proper cleansing, in order to prevent the potential for infection to develop and for less noticeable scarring. Appropriate cleaning measures include washing the wound clean of dirt and debris, as well as disinfecting to remove any germs. Wound cleansing is universal for all laceration repair preparation, regardless of the repair technique that will be employed. Additional preparation can include removing any jagged tissue edges to reduce the appearance of scarring as the wound heals.

For lacerations of a more minor nature, individuals may clean the wound themselves with several different solutions, including antiseptic solution, sterile saline solution, or tap water. Infection risk from using tap water depends upon the water quality of your current environment.

In general, it is not necessary to use antibiotics to address open wounds that are clean; however, should the wound be contaminated, or a bacterial culture come back positive, antibiotics may be used.

No wound is ever to be closed if there is suspicion of infection. It is advised that open wounds receive cleaning twice daily, using soap and warm water, and should afterwards be bandaged with moist gauze, followed by dry gauze, and then protective bandaging.

Laceration Repair: Wound Closure                                 

Great care must be taken in regard to understanding how old the wound is before closure is attempted. Wounds that have been open less than 12 hours may be prepared, cleansed, and closed using sutures or staples. Lacerations more than 24 hours old could be contaminated and ought not to be closed completely. Several techniques may be employed for the closing of the wound, including bandaging, staples, cyanoacrylate glue, and sutures.

To repair a tear incurred by slamming your finger in the car door, it is likely you would need finger laceration repair that includes sutures to close up the wound. Sutures, commonly referred to as “stitches,” are implemented to repair lacerations that are deep, expose muscle or fat, are bleeding, or have jagged edges. Before sutures are used, iodine is applied to the edges of the tissue and skin needing closure. A surgical drape may also be employed to maintain a sterile environment during the procedure.

For lacerations in which muscle and other underlying tissues are in need of repair, there may be multiple layers of sutures that need to be used before closing the wound. Sutures placed in tissues underneath the skin are made of absorbable materials and will not be removed.

  • Dr. Nate Whittaker, MD Emergency Medicine Specialist
How Did We Get Here? The History of Sutures

How Did We Get Here? The History of Sutures 0

The sutures we benefit so greatly from today haven’t always been sterile, smooth, and specialized. Over thousands of years, the materials and methods have been improved to give us our modern standards of suturing. But just how far have we come? Check out the evolution of sutures below. 

 

  • 30,000 B.C.

Introduction of eyed needles

The fossilized remains of some Neolithic skulls suggest that the world’s first eyed needles were used for surgical purposes, as well as to tie wounds together, at this time.

 

  • 1,600 B.C.

Catgut is implemented as a suturing staple

Catgut (created by twisting sheep or horses intestines) or silk was used by Galen of Pergamon, a Greek surgeon, to repair the severed tendons of gladiators in his day. Sutures of similar material were used well into the 20th century.

 

  • 150 A.D.

Egyptians use sutures for the first time

In Egyptian records, the first historical suture reference is made in regards to treatment of a shoulder wound, directing the drawing together of a gash using stitching.

 

  • 1876

One man’s speech influences the future of surgery

In the 1800s, surgeons performed operations in their regular street attire and used the same instruments and dressings for each patient they saw, which were not cleansed before reuse. It was at the Philadelphia Centennial Exhibition’s Medical Congress that Sir Joseph Lester, a British surgeon, gave a presentation that inspired Robert Johnson—a medicated plaster maker—to create Johnson & Johnson with the purpose of furthering the sterile surgery cause.

 

  • 1920s

Mersutures are invented

George Merson, a Scottish pharmacist and manufacturer of surgical sutures, created an eyeless, needled suture with a single line of material attached by the butt end of the needle. As a result, tissue damage in patients was greatly decreased, as it eliminated the double-strand that was previously pulled through the skin.

 

  • 1960

Sterilization through irradiation is introduced

Merson’s company was acquired and absorbed by Johnson & Johnson in 1949, which renamed the newly-forged company Ethicon Suture Laboratories. This company, renamed Ethicon Inc. in 1950, introduced a technology that utilized radiation to sterilize sutures. This was a tremendous breakthrough in sterile sutures, as the process took place after the sutures had been sealed in their packaging.

 

  • 1974

Vicryl sutures are invented

The introduction of Vicryl, a synthetic suture created by Ethicon, was able to be naturally absorbed into the skin. It also featured a braided structure, giving it added pliability and strength.

 

  • 1993

Monocryl sutures hit the market

Monocryl, created specifically for skin, has high initial strength and provides the skin with a closing that is more secure, helping prevent infection and scarring that can occur when wound edges aren’t closed properly.

 

  • 2003

Antibacterial sutures are introduced

Coated Vicryl plus antibacterial sutures were the first version of antibacterial suture featuring triclosan, which protected the suture from bacteria. This significantly reduced infection risk in the surgical site by nearly one third.

 

  • 2012

The Stratafix Knotless Tissue Control Device is created

This type of suture addressed the tiresome, time-consuming requirement of suturing tissues together via knotting individual loops. Comparable to a zipper, it features multiple fixation points, eliminating the need to create knots (or “buttons”), and provides greater efficiency and strength than the traditional suture method.

  • Dr. Nate Whittaker, MD Emergency Medicine Specialist
Don't let an injury cut the Hunt short before bringing home your trophy game!

Don't let an injury cut the Hunt short before bringing home your trophy game! 0

You don't have to cut your hunting trip short if an accident happens. Be prepared for the accidental pocketknife finger cut, the rifle-scope kickback facial laceration, and other common hunting accidents.

 

Be prepared for lacerations in the outdoors.

  • Dr. Nate Whittaker, MD Emergency Medicine Specialist
How to Use a Staple Removal Kit for Safe Staple Removal

How to Use a Staple Removal Kit for Safe Staple Removal 0

Due to the fact that surgical staples are most often used for repairing wounds in the skin, having the right instrument to remove surgical staples, such as, a staple removal kit, is extremely important for removal when considering comfort and convenience. After a patient has had a procedure requiring staples, the last thing they want to think about is uncomfortable removal, so a tool that has been specifically designed for the job is essential. However, there are more aspects to consider than just the right tools when it comes to proper staple removal.

Preparation of Staple Removal Site

The site of the stapled incision needs to be properly cleaned using a surgical skin prep solution or an antiseptic solution before you begin to remove any staples from the skin, as there may be bacteria in any dried blood or scabs that remain on the incision area. Solutions that will do the job are varied, but can include 70% isopropyl alcohol or a betadine/iodine solution. Remember to properly clean the staples in addition to the surrounding skin. It is recommended that you use disposable gloves to protect yourself and the patient from possible contamination during the process.

Aligning the Staple Remover

When removing surgical staples, it is important that the staple remover be positioned correctly. To do this, position the lower jaw of your staple remover beneath the staple. Take care that the remover is in the center of the staple and aligned so that it is parallel with the incision below. The remover’s upper jaw will then be lying over the staple’s mid-portion.

Disengaging the Staple

With the staple remover precisely aligned, you may now gently squeeze the two handles of the remover, keeping the force consistent. As this pressure is applied, the remover will begin to make a downward bend in the staple, causing the tines, or legs, to disengage from the skin by springing open. You may then gently guide the staple up and out of the incision site. Repeat this process for each staple. It is important to keep in mind that during the staple removal process, it may be necessary to “fire” the remover multiple times to successfully separate the staple from the patient’s skin.

Post-Removal Skin Care

Once all of the staples have been removed from the incision site, make sure to clean the skin and incision of any blood using proper cleansing solutions. Depending on the patient, it may be necessary to employ bandages or other external dressings to absorb possible drainage from the small staple punctures.

When caring for a wound of any kind, using the proper preparation techniques, tools, and post-procedural care is the best way to ensure efficient, infection-free healing. For this purpose, it is highly recommended that you use a staple removal kit, rather than regular household tools, to remove any staples during a healing process. Keeping your cleansing solutions, bandages, and other first aid kit products well-stocked and easily accessible will enable you to handle a variety of injuries in any situation.

  • Dr. Nate Whittaker, MD Emergency Medicine Specialist
What You Should Have in Your First-Aid Kit

What You Should Have in Your First-Aid Kit 0

Nobody plans on needing to administer first-aid, at least not in the typical setting of everyday life, but it’s always a good idea to have a carefully stocked first aid kit on hand should the need arise. Keep one in a specific place that’s easy to access in your home. The kitchen is a good place for it, as the humidity in bathrooms can shorten the life of certain supplies. You also ought to keep one in the car for any necessary care during vacations or outings. If you have children, talk with them about how to treat everyday scrapes and cuts, and what to do in an emergency.

First-aid kits can come pre-assembled, or you may decide you want to create your own to fit any family preferences or needs, like cartoon bandages or ointment you know you aren’t allergic to. Whether you’re building your own kit or buying one from the store, here are important supplies and materials that ought to be included:

The Basics

  • Antiseptic towelettes and solution
  • Antibiotic ointment
  • Hand sanitizing agent or soap
  • Cotton swabs or cotton balls
  • Several pairs/sizes of non-latex, disposable gloves
  • Various sizes of bandage strips, including butterfly bandages
  • Various sizes of gauze and sterile, nonstick bandages
  • Elastic wrap bandaging
  • Adhesive tape
  • Eyewash solution
  • Thermometer
  • Aluminum finger splint
  • Instant cold packs
  • Syringe
  • Medicine spoon or cup
  • Various sizes of safety pins
  • Various sizes of plastic bags
  • Duct tape
  • Bulb suction device for flushing of wounds
  • Breathing barrier
  • Lubricant, such as petroleum jelly
  • Sunscreen
  • Insect repellent
  • First-aid manual
  • List of inventory

Medication

  • Pain relievers, such as ibuprofen (Advil, Motrin IB, etc.), acetaminophen (Tylenol, etc.), and aspirin (never for children)
  • Antihistamines, such as diphenhydramine
  • Antacids
  • Hydrocortisone cream
  • Calamine lotion
  • Aloe vera gel
  • Anti-diarrhea medication
  • Laxatives
  • Cold and cough medications
  • Personal medication that does not require refrigeration
  • Auto-injector of epinephrine (as prescribed by your physician)

For Emergencies

  • Phone numbers of emergency contacts, including your family doctor, pediatrician, poison control, local emergency services, emergency road service providers, and any family or friends you wish to be notified in the event of an emergency situation
  • Medical consent forms—one for each member of your family
  • Medical history forms—one for each member of your family
  • Waterproof headlamp or flashlight with extra batteries
  • Pack of waterproof matches
  • Waterproof writing instrument and notepad
  • Space blanket
  • Cell phone and solar charger
  • Whistle
  • Small mirror

Keep Your Kit (And Yourself) Up To Date

It’s important to be familiar with the inventory of supplies in your first aid kit. For instance, it can be easy to raid the bandage and medication stock while on the road, or if you run out of your usual stores at home, so these need to be restocked. Make yourself a reminder to check expiration dates on medications, refill any necessary prescriptions, test battery life, and replenish any used supplies regularly. Review your first-aid manual to make sure you and your family members know how to handle situations that call for more than a quick cleaning and bandage. You may also choose to enroll yourself or your children in local classes that teach how to administer first-aid and use your first-aid kit properly. Take whatever measures you need in order to make sure that you and your family is safe. We hope this list has been helpful for you to be prepared for any situation.
  • Dr. Nate Whittaker, MD Emergency Medicine Specialist