Wounds and open fractures

27 Wounds and open fractures


A large variety of wounds may be seen in emergency patients, resulting from a range of different causes, and an extensive discussion is beyond the scope of this book. This chapter briefly presents some general considerations and the reader is referred to other texts for more extensive wound-specific management and surgical closure.



Clinical Tip



• A large proportion of patients presenting with wounds or open fractures have suffered significant multisystemic injury (see Ch. 28). It is essential to ensure that as far as possible the fundamental principles of emergency medicine are not sacrificed at the expense of focusing on the wound(s). Major body system examination, cardiorespiratory stabilization and adequate pain relief should be prioritized as always; wounds and fractures are rarely life-threatening.

Wound management centres on the following steps:


• Haemostasis is provided if required

• Further contamination should be minimized

• Non-viable tissues should be debrided

• Contaminating material should be removed

• Drainage should be ensured

• A viable vascular bed should be encouraged

• The wound should be closed appropriately.



Providing haemostasis


In most cases adequate haemostasis can be provided by direct pressure over the wound using sterile gauze swabs. Occasionally it is necessary to clamp a bleeding artery or arteriole until further intervention can be performed.



Minimizing further contamination


Traumatic wounds that receive adequate debridement and lavage within 6–8 hours of injury may be converted from contaminated to clean. However, a number of animals presenting with wounds require extensive major system stabilization before such wound management can be instituted, and stabilization should never be sacrificed over concerns regarding wound contamination.


Until such time that more thorough wound cleansing can be performed, it is important to adhere to certain guidelines:


• Aseptic technique should be employed when handling wounds as far as possible.

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Sep 3, 2016 | Posted by in SMALL ANIMAL | Comments Off on Wounds and open fractures
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