– A simple wound is a break in the skin depth limited continuity fatty subcutaneous tissue without achieving noble tissues (muscle, bone, joint, large arteries, nerves, tendons) and without significant loss of substance.
– The treatment aims to ensure rapid healing without infectious complications or sequelae. There are a number of simple rules:
• rapidly treat wounds respecting aseptic technique and timing of initial gestures: washing-exploration-trimming;
• identify suturing wounds and those for which a suture would be harmful or dangerous;
• immediately suture recent simple wounds (less than 6 hours) and slightly contaminated or delay suturing highly contaminated wounds and / or older;
• prevent the risk of local infection (abscesses) or general (gas gangrene, tetanus).
Equipment:
Instruments (Figures 1a-1d):
– One dissecting forceps, a needle holder, a pair of surgical scissors, forceps or Kocher Péan are usually sufficient.
– One or two artery forceps, a pair of spacers Farabeuf, a knife can be useful for a contused or deep wound.
Instruments to suture a patient must be packaged and sterilized packages (box or set to wound suturing) to minimize handling, fault sources aseptic.
Consumables:
– Local anesthesia: sterile syringe and sterile needle, 1% lidocaine (without epinephrine)
– Sterile gloves, sterile hole field
– Threads absorbable suture absorbable and non-sterile
– Antiseptic and necessary to dressing
– Drainage: rubber blade, nylon bristles for fixing
Technique:
– Place the patient comfortably, have all the necessary equipment and with adequate lighting.
– Explain to the patient the course of care and obtain his cooperation.
– Faced with a young child, provide with an assistant to hold it if necessary.
Initial washing:
– Wear appropriate clothing: sterile gloves in all cases, over-blouse and goggles there is a risk of projection by a bleeding wound.
– Perform a wash even more prolonged that the wound is dirty. Use water and regular soap or povidone iodine foam solution and rinse.
– Use a sterile brush if necessary and prefer a runoff by washing rather than by immersion.
– An already infected wound associated with general signs (hyperthermia, chills, poor general condition) may justify systemic antibiotics at least an hour before starting the wash.
Exploration:
– Wash hands and put on sterile gloves.
– Brush largely the wound and surrounding skin with povidone iodine 10%.
– Cover the wound with a sterile hole field.
– Conduct a local anesthetic lidocaine 1% stinging in the wound edges and wait at least 2 minutes for the product to work.
– Proceed carefully to the surface to the depth to explore the entire wound and subcutaneous detachment areas. Get help from an assistant if necessary.
– Take into account the anatomical location of the wound to search for an infringement fine fabrics (clinical examination member underlying the wound of an engine point of view of tendons is a prerequisite that guides the exploration surgical):
• wound communicating with a fracture is an open fracture,
• a wound near a joint can be a joint wound,
• wound of the hand or foot can reach the nerves and / or tendons,
• wound next to a large artery can be an arterial wound although it stopped bleeding.
– Look for and remove any foreign bodies.
– The exploration must be conducted in the operating whenever it can not be complete block (for pain or significant bleeding for example).
Trimming:
– The wound debridement is the removal of all devitalized tissue that promote bacterial growth and infection.
– Trimming is reduced or zero if net wound. It is even larger than the wound is bruised, irregular and extended.
– Excise economically skin wound edges, especially on the face.
– Excise widely subcutaneous tissue and fat whose vitality is doubtful to leave only well-vascularized tissue.
Immediate suture wounds simple:
– Immediate suturing of a simple wound can have dramatic consequences for the patient if the conditions for healing without infection are not met.
– The decision of immediate suture should be taken only after washing, satisfying exploration and debridement of the wound and the following conditions: simple wound older than 6 hours and no longer containing devitalized tissue or contused (this time may be increased to 24 hours if it sits on the face, scalp, upper limb or hand).
– Bites, gunshot or shrapnel or mine should not be sutured immediately.
Suture wounds delayed simple:
– Wounds that do not meet the above conditions should not be sutured immediately.
– After washing, trimming and exploration, a simple dressing is applied to the open wound.
– Daily dressings provide an additional wound cleansing and removal of dead tissue remaining.
– After 72 hours and in the absence of local signs of infection, the wound may be sutured.
Directed healing of infected wounds:
If the conditions of cleanliness of the wound are not met, the healing will be achieved without suture, either spontaneously (directed healing) or skin grafting (once the wound clean) if the defect is important.
