WORLDMED CENTER Phi Phi

Wound Management

Travelling in Thailand, there are many extreme activities. Sometimes, You might get some wounds from accident on your activities. Especially in PhiPhi Islands, just walking on the beach, you might have wound easily on your bare feet. Every wounds can let you have infection even small wound if it not be care properly and correctly.

The basic principles for the management of a wound or laceration are

Haemostasis

Haemostasis is the process that causes bleeding to stop. In most wounds, haemostasis will be spontaneous. In cases of significant injury or laceration of vessels, steps may need to be taken to reduce bleeding and aid haemostasis. These include pressure, elevation, tourniquet, and suturing

Cleaning the Wound

Wound cleaning is important for reducing infection and promoting healing. There are five aspects of wound cleaning

  • Disinfect the skin around the wound with antiseptic.
    • Avoid getting alcohol or detergents inside the wound.
  • Decontaminate the wound by manually removing any foreign bodies.
  • Debride any devitalised tissue where possible.
  • Irrigate the wound with normal saline
    • If there is no obvious contamination present, low pressure irrigation is sufficient (pouring normal saline from a sterile container carefully into the wound)
    • If the wound is clearly contaminated, it must be irrigated at high pressure (via a green needle and syringe) to remove any visible debris present.
  • Antibiotics are advised in high-risk wounds or signs of infection (follow local antibiotic guidelines)
    • Risk factors for wound infection include foreign body present or heavily soiled wounds, bites (including human), puncture wounds and open fractures.

Analgesia

Analgesia will allow for a humane and easier closure of the wound. Infiltration with a local anaesthetic is the most common form of analgesia used, with regular systemic analgesia (paracetamol/Ibuprofen) used as an adjunct.

Skin closure

The aid wound healing, the edges of the wound can be manually opposed. There are four main methods of doing so; skin adhesive strips, tissue adhesive glue, staples, and sutures:

  • Skin adhesive strips are suitable if no risk factors for infection are present
  • Tissue adhesive glue can be used for small lacerations with easily opposable edges; a popular choice in paediatrics
  • Sutures are typically used for any laceration greater than 5cm, deep dermal wounds, or in locations that are prone to flexion, tension, or wetting
  • Staples can be used for some scalp wounds.

Dressing and follow-up advice

  • Correct dressing of the wound will reduce infection and contamination. When applying a wound dressing to a non-infected laceration, the first layer should be non-adherent (such as a saline-soaked gauze), followed by an absorbent material to attract any wound exudate, and finally soft gauze tape to secure the dressing in place.
  • Tetanus prophylaxis is required for any individual not up to date with (or unsure of) their tetanus immunisation status. A fully immunized person will have had a primary course of three vaccines followed by two boosters spaced 10 years apart. In a wound that is unlikely to become infected tetanus prophylaxis is not required.
  • Following initial wound management, advise patients to:
    • Seek medical attention for any signs of infection (increasing pain, tenderness, redness, or swelling) or general malaise and fever.
    • Take simple analgesia (e.g. paracetamol or ibuprofen).
    • Keep the wound dry as much as possible, even if wearing a waterproof dressing.
  • Any sutures or adhesive strips should be removed 10-14 days after initial would closure (or 3-5 days if on the head); tissue adhesive glue will naturally slough off after 1-2 weeks. Remove dressings at the same time as the sutures or adhesive strips.

Reference: http://teachmesurgery.com/skills/wounds/management/ 

Minor Surgery

Wound care and Dressing

Special dressing material

BACTIGRAS

BACTIGRAS is indicated for adjunctive treatment and prevention of infection in skin loss lesions, including wounds, burns and ulcers.

Composition of Chlorhexidine Acetate BP 0.5% in white soft paraffin BP

  • Should not be used in known cases of sensitivity or allergy to chlorhexidine
  • Avoid contact with eyes, middle ear, meninges and brain
BACTIGRAS
BACTIGRAS

BluRibbon

BluRibbon has been developed with preclinical and clinical tests with proven results of giving better and faster wound healing effect compared to the conventional wound dressing products especially for the hard-to-heal wounds e.g. diabetic foot ulcers, pressure sore, cavity wounds etc. that helps improving the treatment efficiency, improving patient’s quality of life, reducing burdens of patient’s family and also helps making healthcare personnel’s job easier.

BluRibbon is contraindicated in patients with a known, or suspected, sensitivity to Silver

BluRibbonCase

Blue Gel

BluGel is used to debride dead tissue in shallow wounds, cavity wounds, or infected wounds such as pressure ulcer, diabetic wounds, leg ulcers etc. It can also be applied to burns and bruised wounds.
BluGel is contraindicated in patients with a known, or suspected, sensitivity to Silver

BluGel

UrgoCell Ag/Silver

Urgocell Silver is an antibacterial foam dressing with TLC-Ag. It is made of an antibacterial contact layer with TLC-Ag (polyester mesh impregnated with hydrocolloid, petroleum jelly and silver particles), combined with an absorbent foam pad and a semi-permeable backing.

  • known sensitization to silver and other ingredients of the dressing
  • do not use on patients undergoing MRI examination
UrgoCell

UrgoStart

UrgoStart is a Protease Inhibitor dressing combining a soft-adherent TLC-NOSF layer (Technology Lipido-colloid and Protease Inhibitor particles), with an absorbent foam pad and a semi-permeable backing.
UrgoStart is contraindicated in wounds such as cancerous wounds or fistula wounds which may reveal a deep abscess.

UrgoStart

UrgoClean

UrgoClean is indicated for sloughy wounds (leg ulcers, pressure ulcers, diabetic, acute or chronic wounds)

  • Do not use UrgoClean in combination with hydrogen peroxide, organomercuric antiseptics or hexamidine.
  • Do not use if there is a known sensitivity to UrgoClean
UrgoClean

UrgoTul SSD

Urgotul SSD is an antibacterial contact layer with TLC-Ag Technology (polyester mesh impregnated with hydrocolloid, petroleum jelly and silver sulphadiazine particles).

  • Known sensitization to silver and other ingredients of the dressing
  • Do not use on patients undergoing MRI examination
  • Avoid contact with electrodes or conductive gels during electronic measurement procedures.
UrgoTul
UrgoTul
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