Clinical Pathways
Clinical Pathways
Acute Traumatic Wounds
Acute Traumatic Wounds

Acute Traumatic Wounds

Tags
Emerg. Med. Practice
Published
December 15, 2021
Author(s)
Stacey Barnes, DO; Katrina D’Amore, DO, MPH; Marco Propersi, DO; Miguel Reyes, MD

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Decision

Does the wound have any high-risk factors?

  • Infected (Class I)
  • Contaminated and cannot be cleaned thoroughly (Class II)
  • Not on head or neck (Class I)
  • Sustained >19 hours before presentation

Yes

  • Choose closure method:
    • Delayed primary closure

      • OR

    • Closure by secondary intention
  • If systemic infection is present, admit for IV antibiotics

Background

Examination of wounds should include documentation of the location, size, depth, and shape; wounds should also be examined for signs of contamination, foreign bodies, infection, or devitalized tissue. Wound size, contamination with foreign material, and location other than the head or neck are factors associated with higher infection rates. Assessment of the patient’s neurovascular status is crucial, as this helps determine the extent of the injury. Expert consultation may be warranted if deeper structures such as tendons, muscles, or bones appear to be involved on wound exploration.

Primary closure with sutures, staples, or adhesives is recommended when acute wounds have adequate approximation. In secondary closure, the wound is allowed to heal with the formation of granulation tissue; this method is preferred when there is poor wound approximation, contamination, or delay in presentation. In delayed primary closure, the wound is cleaned and observed for several days, then surgically closed.

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