Priorities

Unless airway and breathing are compromised or there is active bleeding from the wound edge, acute traumatic wounds are evaluated and treated after other life- or limb-threatening conditions have been evaluated and managed. To maximize patient safety and comfort, it is generally best to evaluate patients supine on a stretcher. Hemostasis may be required and is best done by local pressure. Sometimes, wound repair must be delayed to address other issues. In this case, fresh wounds should be covered by saline-moistened gauze to prevent drying. Most wounds can be assessed without analgesia and anesthesia, provided the physician proceeds slowly and carefully. Encircling clothing, rings, and jewelry should be removed as soon as possible to reduce the potential for damaging edema and contamination.

Wound repair has been traditionally divided into three categories. Primary closure (healing by primary intention) is performed with sutures, staples, or adhesives at the time of initial evaluation. Secondary closure (healing by secondary intention) is where the wound is allowed to granulate and fill in with eventual epithelialization with only cleaning and minimal debridement. Tertiary closure (delayed primary closure) is where the wound is initially cleaned, debrided, and observed for a period of time (typically 4 or 5 days) before closure.

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