Wound management: classify by age, contamination, tissue involvement. Copious lavage is key. Primary closure for clean acute wounds; second intention for contaminated or infected. Three-layer bandaging: primary (contact), secondary (absorbent), tertiary (outer).
Wounds are classified by age, contamination, and tissue involvement. Age: Acute (less than 6-8 hours) vs. chronic. Contamination: Clean (surgical, aseptic); clean-contaminated (minimal spillage); contaminated (gross spillage, trauma); dirty (infected, devitalized tissue). Tissue involvement: Superficial (skin only); partial-thickness (into dermis); full-thickness (through skin); deep (involving muscle, bone, or body cavity). Classification guides closure decisions and antibiotic use.
Copious lavage is the most important step in wound preparation. Use sterile saline or lactated Ringer's; tap water is acceptable for initial field lavage. Volume matters more than pressure: 500 mL to several liters, delivered with a 35-60 mL syringe and 18-gauge needle or a pulsatile lavage system. High-pressure lavage can drive bacteria deeper; use low to moderate pressure. Add dilute chlorhexidine (0.05%) or povidone-iodine (0.1-1%) for contaminated wounds, but avoid full-strength antiseptics—they are cytotoxic to healing tissue. Lavage until the wound is visibly clean.
Primary closure (suturing at the time of presentation) is appropriate for clean, acute wounds with minimal contamination and good tissue viability. It provides faster healing and better cosmetic results. Second-intention healing (allowing the wound to granulate and epithelialize) is chosen when: the wound is contaminated or infected; tissue viability is uncertain; there is excessive tension; or the wound is chronic. Delayed primary closure (closure 3-5 days after injury, once the wound is clean and granulating) is a middle option.
| Closure Type | Indications | Healing Time |
|---|---|---|
| Primary | Clean, acute, good tissue | 7-14 days |
| Delayed primary | Contaminated, improved after lavage/drainage | 10-14 days |
| Second intention | Infected, necrotic, high tension | Weeks to months |
Bandages protect wounds, absorb drainage, and support healing. The three-layer principle: primary layer (contact)—non-adherent (e.g., petrolatum-impregnated gauze, silicone mesh) for granulating wounds; wet-to-dry for debridement (use with caution—can damage granulation tissue). Secondary layer (absorbent)—gauze or cast padding to absorb exudate and provide padding. Tertiary layer (outer)—conforming wrap and tape to secure the bandage. Change bandages based on drainage: daily for heavily exudative wounds, every 2-3 days as healing progresses. Monitor for swelling above or below the bandage, odor, or patient discomfort—signs of bandage-related complications.
Monitor for signs of infection: increased swelling, redness, warmth, purulent discharge, or dehiscence. Systemic signs (fever, lethargy, inappetence) warrant recheck. Elizabethan collars prevent self-trauma. Restrict activity to allow healing. Remove sutures at 10-14 days for most skin closures; longer for high-tension areas or compromised healing. Document wound progression with photos to track healing and guide client communication.
Upload wound photos for AI-assisted assessment with the Wound Assessment AI and get guidance on management from the Post-Op Care Specialist.
- Classify—age, contamination, tissue involvement.
- Lavage—copious volume (500 mL+); low-moderate pressure; avoid full-strength antiseptics.
- Primary closure for clean acute; second intention for contaminated/infected.
- Three-layer bandage—primary (contact), secondary (absorbent), tertiary (outer).
- Monitor for infection, dehiscence; remove sutures at 10-14 days.