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.
Wound management centres on the following steps:
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: