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Wound treatment

Last updated: November 11, 2020


Wounds are defined as a disruption of the normal structure and function of skin and underlying soft tissue that is caused by trauma or chronic mechanical stress (e.g., decubitus ulcers). Wounds can be broken down into acute or chronic, and open or closed. Wound treatment is performed according to pathology, the extent, and circumstances of the lesions. To heal, the wound needs to have a vascular supply, be free of necrotic tissue, clear of infection, and moist. General wound treatment includes surgical wound closure, open wound treatment, and plastic reconstruction of skin defects. In addition, infectious or concomitant disease prevention should be considered (e.g., antibiotic therapy, vaccines for tetanus and rabies, diabetes control). Surgical intervention is usually required with traumatic injuries, whereas chronic wounds and ulcers can often be treated conservatively. In the case of severe or nonhealing wounds, surgical intervention including debridement may be necessary. Wound complications, particularly after abdominal surgery, include hematomas and seromas, infection, wound dehiscence and evisceration, and fistulas of the GI tract.


Acute vs. chronic wounds [1]

  • Acute wound: a disruption of the skin and/or underlying soft tissue that has a well-organized healing process with predictable tissue repair
    • Stab wounds
    • Lacerations
    • Bruises
      • Rupture of blood vessels within the skin as a result of direct trauma, with the surface of the skin remaining intact
      • Can also occur in muscles, bones, and internal organs
  • Chronic wound: a wound with an impaired healing process, usually involving a prolonged or excessive inflammatory phase, persistent infections, formation of drug-resistant microbial biofilms, and the inability of cells to respond to reparative stimuli. All chronic wounds begin as acute wounds.

Open vs. closed wounds [2]

  • Open wound: a wound with skin breakage and exposure of underlying tissue to the outside environment
    • Lacerations
    • Gunshot wounds
    • Punctures
  • Closed wound: a wound with intact skin, and underlying tissue not directly exposed to the outside environment

Delayed wound healing

Risk factors for delayed wound healing: DID NOT HEAL

Special wounds

Amputations [4][5]

An amputation is the surgical or traumatic separation of a body part from the rest of the body.

  • Complete amputation: the body part is totally severed
  • Partial amputation: some soft tissue remains connected to the affected body part and the rest of the body
  • Surgical amputations: careful, controlled removal of a body part in the operating room
  • Traumatic amputations: Most traumatic amputations are accidental, and usually result from factory, farm, or power tool accidents. Motor vehicle accidents may also cause traumatic amputations. The tips of longer fingers tend to be injured more often because they are more exposed to harm.
    • Complete fingertip amputation management [5]
      1. Control bleeding by placing direct pressure on the wound and raise the injured area.
      2. Gently clean the amputated part with sterile saline solution.
      3. Cover with gauze dampened with saline.
      4. Place in a watertight bag.
      5. Place the bag in an ice bath in a sealed container.
      6. Head to hospital for urgent assessment.
    • Reimplantation is more likely to be performed for:
      • Short ischemia time
      • Thumb and index fingers
      • Children
      • Dominant limb involved
      • Patients whose occupation depends on motor skills
      • Upper limb amputations > lower limb amputations (as more prostheses are available for lower limb)
  • Complications

Do not allow the amputated part to be in direct contact with ice, because direct contact can cause further damage.

Bite wounds [6]

Bite wounds (caused by animals or humans i.e., “fight bite”) are associated with an increased risk of infection, as the bacterial flora of the oral cavity hinders wound healing.

Bite wounds should receive the same treatment as open dirty wounds.

Stab wounds

  • When performing first aid, do not remove the foreign body from the wound, as this could stop the object's sealing and tamponading effect, which could result in bleeding.
  • Removal in a hospital setting with staff prepared for immediate surgical intervention
  • Treatment: see “Penetrating trauma

Needlestick or sharps injuries

See “Infection prevention and control” article for more information.

Decubitus ulcers

Pressure relief and regular skin care are the most important steps for successful decubitus prevention and treatment.


Acute wound treatment

Open wound treatment

Clean surgical wound treatment

  • Indications:
    • Age of the wound: Primary surgical wound treatment is possible up to 6–8 hours after injury. If the wound is > 8 hours old, see treatment for dirty open wounds.
    • Extent of the wound: The patient should have intact circulation, sensation, and movement.
    • Type of wound: clean, sharply defined wound with adjustable wound edges
  • Localization: Anatomical location of the wound determines healing time (e.g., head wounds heal more quickly than extremity wounds because of increased vascularity).
  • Procedure:
    1. Cleaning and disinfection
    2. Local anesthesia
    3. Inspection
    4. Excision of the wound edges and wound irrigation
    5. Tension-free approximation of the wound edges using suture material or staples
    6. Sterile dressing and immobilization
    7. Tetanus prophylaxis
  • Additional treatment:
    • Pathogen detection: antibiotic treatment
    • Increased risk of infection: prophylactic preoperative antibiotic treatment with activity against pathogens likely to be encountered in the procedure

6–8 hours rule: Primary surgical wound treatment should not be used for injuries older than 6–8 hours because of the high risk of infection!

Dirty wound treatment

  • Indications: The goal is to remove devitalized tissue, contamination, and residual suture material that may disrupt the body's ability to heal.
    • Infected wounds; (e.g., infected surgical wounds with black, necrotic tissue; , often occurs up to 30 days post op, up to 1 year if device is implanted)
    • Wounds with foreign bodies (e.g., bullets, infected surgical wounds with remaining suture material)
    • Bite wounds and other contaminated wounds
  • Procedure
    1. Cleaning via pressured irrigation using warm, isotonic saline
    2. Debridement (removal of dead, damaged or infected tissue to improve the efficiency of wound healing) under local anesthesia to remove devitalized tissue and accumulated debris
    3. Ensure drainage (e.g., inlay, strip of gauze)
    4. Moist dressing and immobilization
    5. Delayed/secondary surgical wound treatment after 3–8 days
    6. Tetanus prophylaxis
  • Additional treatment:

Closed wound treatment

Closed wounds are usually caused by blunt trauma.


Plastic and reconstructive surgery

Skin grafting [10]

Skin grafts may be used to close wounds, prevent fluid and electrolyte loss, and reduce bacterial burden and infection.

Full thickness skin graft (FTSG)

  • Graft: epidermis and dermis (including dermal appendages), usually obtained from areas of redundant and pliable skin (e.g., groin, lateral thigh, lower abdomen, lateral chest)
  • Indications: small, uncontaminated, well-vascularized wounds
  • Advantages: good postoperative cosmetic outcome
  • Disadvantages: high risk of necrosis, secondary injury to the donor area

Split-thickness skin graft (STSG)

  • Graft: epidermis and upper part (¼–¾) of the dermis (without dermal appendages)
  • Indications: many uses; resurface large wounds and mucosal deficits, line cavities, close donor sites of flaps, treat large chronic wounds
  • Advantages: heals well, only superficial secondary defect in donor area, which does not have to be covered
  • Disadvantages: scar formation when graft heals, skin pigmentation change, tendency to contract, more fragile
  • Subtype: mesh graft
    • Graft can be stretched 3–6 times its original size by grid‑like incisions.
    • Suitable for large skin defects

Skin grafts are contraindicated in the case of contaminated wounds or insufficient blood supply.

Composite graft [11]

  • Graft: a graft containing multiple structures, such as skin and other structures like muscles, bones, or cartilage
  • Indications: distal fingertip amputations, nasal reconstructions, ear reconstructions
  • Advantages: heals well, usually includes pedicle containing blood supply, aesthetically pleasing
  • Disadvantages: higher infection rate, increased risk that graft does not take compared to local flaps

Complications of abdominal surgical incisions

Hematomas and seromas [12]

  • Definition: collection of blood (hematoma) or serum (seroma)
  • Pathophysiology: failure of hemostasis or coagulation
  • Clinical features
    • Usually occurs several days after surgery
    • Either asymptomatic or can have swelling, pain, or drainage
  • Treatment
    • Small or asymptomatic: manage expectantly
    • Large or symptomatic: exploration and drainage, followed by wound packing until granulation tissue is formed, then closed by delayed primary intention or by secondary intention
  • Complications: may lead to wound infections as bacteria have access to deeper layers of fascia and can multiply in the stagnant fluid

Skin and soft tissue infections

Fascial dehiscence [12]

  • Definition: fascial disruption due to abdominal wall tension that overcomes tissue or suture strength, or knot security
  • Clinical features
  • Treatment for early dehiscence
    • Cover wound with moist dressing and perform wound exploration and debridement in the operating room (OR).
    • An abdominal binder can be used to keep organs intact while en route to OR.
    • Reapproximate fascial edges.
    • Close with continuous, slowly absorbable suture.
  • Complications
    • Organ evisceration: abdominal organs protrude through the outer abdomen
    • If evisceration has happened, do not use binder, and take to OR immediately.
  • Prevention: : good surgical technique, avoid heavy lifting for 4–6 weeks after abdominal laparotomy

Early fascial dehiscence is a surgical emergency. The mortality rate is 10%.

Intestinal fistulas

  • Etiology
    • A complication of open abdominal surgery, especially when the bowel is frequently manipulated, with possible disruption of bowel anastomosis, inadvertent enterotomy, or small bowel injury.
    • Can occur as early as 8 days from initial laparotomy [13]
    • Other causes: IBD, cancer, irradiation
  • Types
  • Complications: sepsis, fluid and electrolyte abnormalities, malnutrition
  • Treatment [14]
    • Spontaneous closure occurs in at least 30% of patients [15][16]
    • Conservative therapy: rehydration and electrolyte repletion, antibiotics (in case of infections), nutritional support, control of fistula drainage (e.g., ostomy pouch), skin protection
    • Surgical therapy: attempted 1–4 months after trial of conservative therapy if no signs of spontaneous closure are present
      • Lysis of adhesions
      • Resection of abnormal or diseased bowel
      • Reanastamosis of healthy bowel


  1. Demidova-Rice TN, Hamblin MR, Herman IM. Acute and Impaired Wound Healing: Pathophysiology and Current Methods for Drug Delivery, Part 1: Normal and Chronic Wounds: Biology, Causes, and Approaches to Care. Adv Skin Wound Care. 2012; 25 (7): p.304-314. doi: 10.1097/01.ASW.0000416006.55218.d0 . | Open in Read by QxMD
  2. Closed Wound Basics. http://www.woundcarecenters.org/article/wound-basics/closed-wound-basics. Updated: February 14, 2017. Accessed: February 14, 2017.
  3. Tramautic Amputations. http://www.emsworld.com/article/10322826/tramautic-amputations. Updated: June 1, 2006. Accessed: February 14, 2017.
  4. Amputation: traumatic. https://medlineplus.gov/ency/article/000006.htm. Updated: September 22, 2016. Accessed: February 14, 2017.
  5. Endom EE. Initial management of animal and human bites. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/initial-management-of-animal-and-human-bites.Last updated: August 11, 2016. Accessed: February 14, 2017.
  6. Guo S, DiPietro LA. Factors Affecting Wound Healing. J Dent Res. 2010; 89 (3): p.219-229. doi: 10.1177/0022034509359125 . | Open in Read by QxMD
  7. Salkind AR, Kavitha C. Antibiotic Prophylaxis to Prevent Surgical Site Infections. Am Fam Physician. 2011; 83 (5): p.585-590.
  8. Singhal H. Wound Infection. Wound Infection. New York, NY: WebMD. http://emedicine.medscape.com/article/188988. Updated: January 9, 2017. Accessed: February 14, 2017.
  9. Armstrong DG, Meyr AJ. Basic principles of wound management. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/basic-principles-of-wound-management.Last updated: December 4, 2016. Accessed: February 14, 2017.
  10. Kirman CN. Pressure Ulcers and Wound Care. Pressure Ulcers and Wound Care. New York, NY: WebMD. http://emedicine.medscape.com/article/190115. Updated: June 20, 2016. Accessed: February 14, 2017.
  11. Alper N, Sood A, Granick MS. Composite graft repair for distal fingertip amputation.. Eplasty. 2013; 13 : p.ic32.
  12. Mizell JS. Complications of abdominal surgical incisions. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. http://www.emsworld.com/article/10322826/tramautic-amputations.Last updated: March 30, 2016. Accessed: February 28, 2017.
  13. Martin N, Sarani B. Management of the open abdomen in adults. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/management-of-the-open-abdomen-in-adults?source=search_result&search=intestinal%20fistula&selectedTitle=2~94#H632146279.Last updated: August 8, 2016. Accessed: February 28, 2017.
  14. Stein SL. Overview of enteric fistulas. In: Post TW, ed. UpToDate. Waltham, MA: UpToDate. https://www.uptodate.com/contents/overview-of-enteric-fistulas.Last updated: January 23, 2015. Accessed: February 28, 2017.
  15. Haack CI, Galloway JR, Srinivasan J. Enterocutaneous Fistulas: A Look at Causes and Management. Current Surgery Reports. 2014; 2 (10). doi: 10.1007/s40137-014-0071-0 . | Open in Read by QxMD
  16. Ramirez PT, Frumovitz M, Abu-Rustum NR. Principles of Gynecologic Oncology Surgery. Elsevier B.V. ; 2018
  17. BLOODBORNE INFECTIOUS DISEASES: HIV/AIDS, HEPATITIS B, HEPATITIS C. https://www.cdc.gov/niosh/topics/bbp/emergnedl.html. Updated: October 5, 2016. Accessed: June 2, 2020.