Wound hygiene eg, cleansing, irrigation, and debridement , including thorough examination of the wound and surrounding tissues, promotes uncomplicated healing of traumatic skin wounds and is required prior to wound closure. Wound healing is impaired by various factors eg, bacterial contamination, foreign bodies, wound ischemia, host factors.
All traumatic wounds are assumed to be contaminated. The goal of wound hygiene is to reduce the contaminant burden without causing further tissue damage or introducing more contaminants. Diagnosis and management of foreign bodies in wounds are a critical part of wound hygiene. Occasionally, identified or suspected foreign bodies are deeply seated, requiring referral to a surgical specialist. Tissue ischemia due to features of the wound or locally poor circulation. Disorders affecting peripheral vasculature eg, diabetes, arterial insufficiency.
Type of injury eg, a crush-type injury, which damages the microvasculature. Repair techniques eg, overly tight sutures. Use of cautery. Bacterial proliferation. Wound hematoma. Foreign material including deep dermal suture material. Significant wound contamination as typically occurs in bite wounds. Antiplatelet drugs and anticoagulants.
Drugs that suppress inflammation eg, corticosteroids, immunosuppressants. Certain disorders. Disorders that suppress the immune system or impair healing eg, chronic kidney disease. Undernutrition eg, protein-calorie undernutrition, deficiencies of specific nutrients such as vitamin C. Disorders of collagen synthesis eg, Marfan syndrome , Ehlers-Danlos syndrome. See also Lacerations. Traumatic skin wounds. Absolute contraindications.
Relative contraindications. Wounds of highly vascularized skin eg, scalp and face may not need irrigation. Puncture wounds should be irrigated and debrided at the surface, particularly if secondary to cat bites, given their high likelihood of infection. However, the value of deep probing, irrigation, and coring is not certain.
