Wound Care

Care of the debrided wounds should allow for additional chemical debridement, prevent reinfection and promote natural healing and granulation.

Hydrogen peroxide, Eusol, povidone iodine, and sodium hypochlorite (Dakin solution) are the agents most often used (Jones et al. 1979; Paty and Smith 1992; Heja-se et al. 1996; Edino et al. 2005). Eusol (Edinburgh University solution) is a chlorinated disinfectant included in the World Health Organization's "essential therapeutic group" of agents. It consists of calcium hypochlorite 1.25 g and boric acid 1.25 g in 100 ml sterile water. Even if not commercially available, it can be easily prepared by the hospital dispensary, and is an inexpensive and effective agent for use in developing countries. Simple irrigation with sterile saline solution to keep dressings moist can be very effective in cleansing large open wounds. Honey has also been used, because its high os-molarity and low pH make it a good desloughing agent, while it increases local oxygen concentration and helps with wound epithelialization (Hejase et al. 1996). Pseudomonas wound infection, characterized by its distinctive odor and green residue on the dressings, can be effectively treated with 5 % acetic acid dressings.

Once the patient is stable and in an anabolic state with granulating wounds, reconstruction of the denuded areas can be done (Fig. 6.4). Skin grafting should on

Fig. 6.4.Well granulated areas ready for skin transplantation

ly be performed if the wounds are clean and healthy, with a negative bacterial swab culture.

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