WOUND MANAGEMENT M. Scott Linscott, MD University of Utah

WOUND MANAGEMENTWOUND MANAGEMENT

M. Scott Linscott, MDM. Scott Linscott, MD

University of UtahUniversity of Utah


Wound assessmentWound assessment Wound anesthesiaWound anesthesia Wound debridementWound debridement Wound preparationWound preparation AntibioticsAntibiotics Wound closureWound closure DressingsDressings

FACTORS THAT INCREASE RISK OF INFECTIONFACTORS THAT INCREASE RISK OF INFECTION

Prolonged time since the injuryProlonged time since the injury Crush injury (vs sharp injury - knife, glass, etc.)Crush injury (vs sharp injury - knife, glass, etc.) Puncture WoundsPuncture Wounds Bite woundsBite wounds Heavily contaminated wounds, esp. over bursaeHeavily contaminated wounds, esp. over bursae Wounds with risk of foreign bodiesWounds with risk of foreign bodies All of the above wounds are considered “dirty”All of the above wounds are considered “dirty”

PROLONGED TIME SINCE INJURYPROLONGED TIME SINCE INJURY

FACE / SCALP > 24 HRSFACE / SCALP > 24 HRS ARM > 18 HRSARM > 18 HRS HAND > 12 HRSHAND > 12 HRS TRUNK > 12 HRSTRUNK > 12 HRS LEG > 8 HRSLEG > 8 HRS FOOT > 6 HRSFOOT > 6 HRS

PUNCTURE WOUNDSPUNCTURE WOUNDS

SHOULD NEVER CLOSE, ESP. IF ANIMAL SHOULD NEVER CLOSE, ESP. IF ANIMAL BITESBITES

ON BOTTOM OF FEET, DO NOT IRRIGATEON BOTTOM OF FEET, DO NOT IRRIGATE IF POSSIBILITY OF GLASS, ETC. IF POSSIBILITY OF GLASS, ETC.

(RUNNING ON BEACH), MUST X-RAY OR (RUNNING ON BEACH), MUST X-RAY OR DO ULTRASOUND (IF SUSPECT WOOD OR DO ULTRASOUND (IF SUSPECT WOOD OR OTHER ISODENSE FB) TO R/O FBOTHER ISODENSE FB) TO R/O FB

BITE WOUNDSBITE WOUNDS

DO NOT CLOSE IF PUNCTURE WOUNDSDO NOT CLOSE IF PUNCTURE WOUNDS IF CAT BITE, DO NOT CLOSE LACERATION IF CAT BITE, DO NOT CLOSE LACERATION

(POSSIBLE EXCEPTION: FACE, BUT MUST (POSSIBLE EXCEPTION: FACE, BUT MUST GIVE ANTIBIOTICS PRIOR TO CLOSURE GIVE ANTIBIOTICS PRIOR TO CLOSURE AND DO AT LEAST 1000 CC HIGH AND DO AT LEAST 1000 CC HIGH PRESSURE IRRIGATION)PRESSURE IRRIGATION)

DO NOT CLOSE MOST HUMAN, PRIMATE DO NOT CLOSE MOST HUMAN, PRIMATE OR DOG BITESOR DOG BITES

ORGANISMS: PASTEURELLA MULTOCIDA, ORGANISMS: PASTEURELLA MULTOCIDA, EICHINELLA CORODONSEICHINELLA CORODONS

BITE WOUNDSBITE WOUNDS

USE PROPHYLACTIC ANTIBIOTICS IN CAT, USE PROPHYLACTIC ANTIBIOTICS IN CAT, HUMAN, PRIMATE AND DOG BITESHUMAN, PRIMATE AND DOG BITES

USE HIGH PRESSURE IRRIGATION AT LEAST 500 USE HIGH PRESSURE IRRIGATION AT LEAST 500 CCCC

RABIES: RABIES: NEVER IN RODENTS NEVER IN RODENTS IF BAT, SKUNK, OR RACCOON, MUST GET RABIES IF BAT, SKUNK, OR RACCOON, MUST GET RABIES

VACCINEVACCINE IF UNPROVOKED ATTACK BY DOG OR CAT AND CAN’T IF UNPROVOKED ATTACK BY DOG OR CAT AND CAN’T

FIND ANIMAL, GIVE VACCINEFIND ANIMAL, GIVE VACCINE IF DOG OR CAT CAN BE FOUND, QUARANTEEN THEMIF DOG OR CAT CAN BE FOUND, QUARANTEEN THEM


BADLY CRUSHED, PUNCTURE WOUNDS, CAT, BADLY CRUSHED, PUNCTURE WOUNDS, CAT, DOG, HUMAN BITES, “OLD” WOUNDS ALL - ”DIRTY DOG, HUMAN BITES, “OLD” WOUNDS ALL - ”DIRTY WOUNDS”WOUNDS”

USE 500-1000 CC IRRIGATION SOLUTION – HIGH USE 500-1000 CC IRRIGATION SOLUTION – HIGH PRESSUREPRESSURE

MAY NEED SHARP DEBRIDEMENTMAY NEED SHARP DEBRIDEMENT IF NOT BITE OR DIRTY BURSAL WOUNDS, IF NOT BITE OR DIRTY BURSAL WOUNDS,

PROPHYLACTIC ANTIBIOTICS PROPHYLACTIC ANTIBIOTICS PROBABLY DON’T PREVENT INFECTIONPROBABLY DON’T PREVENT INFECTION

THOROUGH CLEANING AND DEBRIDING ARE FAR THOROUGH CLEANING AND DEBRIDING ARE FAR MORE IMPORTANT IN PREVENTING WOUND MORE IMPORTANT IN PREVENTING WOUND INFECTIONS THAN ARE PROPHYLACTIC INFECTIONS THAN ARE PROPHYLACTIC ANTIBIOTICSANTIBIOTICS

Physical ExamPhysical Exam Prior to anesthesiaPrior to anesthesia

Always assess neurovascular status distallyAlways assess neurovascular status distally Motor examMotor exam Sensory examSensory exam Circulatory examCirculatory exam

If a volar laceration of hand or finger, have If a volar laceration of hand or finger, have patient flex finger against resistance to R/O patient flex finger against resistance to R/O partial flexor tendon lacerationpartial flexor tendon laceration

Examine extremity wounds under a bloodless Examine extremity wounds under a bloodless field (tourniquet) whenever possiblefield (tourniquet) whenever possible

Examine hand, foot and joint wounds through Examine hand, foot and joint wounds through the full range of motion to detect tendon the full range of motion to detect tendon injuriesinjuries

ANESTHESIAANESTHESIA

LOCAL ANESTHESIA – 1% LIDOCAINE, 0.25% LOCAL ANESTHESIA – 1% LIDOCAINE, 0.25% BUPIVICAINEBUPIVICAINE

REGIONAL ANESTHESIA – 2% LIDOCAINE, 0.5% REGIONAL ANESTHESIA – 2% LIDOCAINE, 0.5% BUPIVICAINEBUPIVICAINE

NO CROSS ALLERGY BETWEEN AMIDES NO CROSS ALLERGY BETWEEN AMIDES (LIDOCAINE, BUPIVICAINE) AND ESTERS (LIDOCAINE, BUPIVICAINE) AND ESTERS (PROCAINE - NOVOCAINE)(PROCAINE - NOVOCAINE)

ALLERGY TO AMIDES IS EXTREMELY RAREALLERGY TO AMIDES IS EXTREMELY RARE LOCAL INFILTRATION – INJECT BELOW DERMIS, LOCAL INFILTRATION – INJECT BELOW DERMIS,

NOT INTO ITNOT INTO IT

DURATION OF ANESTHESIADURATION OF ANESTHESIA

LIDOCAINE 1% LOCAL INFILTRATION: 45 LIDOCAINE 1% LOCAL INFILTRATION: 45 MINMIN

LIDOCAINE 2% NERVE BLOCK: 2 HOURSLIDOCAINE 2% NERVE BLOCK: 2 HOURS BUPIVICAINE 0.25% LOCAL INFILTRATION: BUPIVICAINE 0.25% LOCAL INFILTRATION:

2 HOURS2 HOURS BUPIVICAINE 0.5% NERVE BLOCK: 8-16 BUPIVICAINE 0.5% NERVE BLOCK: 8-16

HRS (AVE-12 HRS)HRS (AVE-12 HRS)

ANESTHESIAANESTHESIA WITH EPINEPHRINE 1:100,000WITH EPINEPHRINE 1:100,000

• DECREASES OOZING, NOT BLEEDINGDECREASES OOZING, NOT BLEEDING• MINIMAL PROLONGATION OF ANESTHESIAMINIMAL PROLONGATION OF ANESTHESIA• PREVENTS ABSORPTION OF LOCAL ANESTHETIC – PREVENTS ABSORPTION OF LOCAL ANESTHETIC –

CAN USE ALMOST TWICE AS MUCH LOCAL CAN USE ALMOST TWICE AS MUCH LOCAL ANESTHETIC – 80 cc of 0.25% BUPIVICAINEANESTHETIC – 80 cc of 0.25% BUPIVICAINE

• AVOID USING NEAR TIP OF NOSE, EARS, FINGERS, AVOID USING NEAR TIP OF NOSE, EARS, FINGERS, TOES, PENIS – MAY CAUSE VASOSPASM AND TOES, PENIS – MAY CAUSE VASOSPASM AND ISCHEMIAISCHEMIA

TOPICALS – TAC, LAT, TA, ETC – MOST USEFUL IN TOPICALS – TAC, LAT, TA, ETC – MOST USEFUL IN CHILDREN FOR SMALL LACS, ESP. ON THE FACECHILDREN FOR SMALL LACS, ESP. ON THE FACE• NEED COMBINATION OF LOCAL ANESTHETIC PLUS EPINEED COMBINATION OF LOCAL ANESTHETIC PLUS EPI• APPLY TO COTTON OR COTTON 4X4, WRING OUT, APPLY TO COTTON OR COTTON 4X4, WRING OUT,

APPLY TO WOUND FOR 15-20 MINUTES APPLY TO WOUND FOR 15-20 MINUTES

COMMON DIGITAL COMMON DIGITAL NERVE BLOCKNERVE BLOCK

Pic 1Pic 1

INSERT 27g 1.25 INCH NEEDLE DORSALLY BETWEEN MC HEADS UNTIL TENTING THE SKIN VOLARLY

SLOWLY WITHDRAW NEEDLE, INJECTING ANESTHETIC AS THE NEEDLE IS REMOVED

RING BLOCKRING BLOCK

WEB SPACE INJECTIONWEB SPACE INJECTION

SUPRAORBITAL NERVE BLOCKSUPRAORBITAL NERVE BLOCK

SUPRAORBITAL NERVE BLOCKSUPRAORBITAL NERVE BLOCK

INFRAORBITAL NERVE BLOCKINFRAORBITAL NERVE BLOCK


PIC 8PIC 8



MENTAL NERVE BLOCKMENTAL NERVE BLOCK



POSTERIOR TIBIAL NERVE BLOCKPOSTERIOR TIBIAL NERVE BLOCK

CLEANING AND DEBRIDING WOUNDSCLEANING AND DEBRIDING WOUNDS

DEBATE RE: SUPERFICIAL/CLEAN WOUNDSDEBATE RE: SUPERFICIAL/CLEAN WOUNDS SCRUBBING WITH SURECLENS/HEBICLENS AND SCRUBBING WITH SURECLENS/HEBICLENS AND

SALINE (1:3) vs…SALINE (1:3) vs… HIGH PRESSURE IRRIGATION (WITH CANYONS HIGH PRESSURE IRRIGATION (WITH CANYONS

IRRIGATION SET)IRRIGATION SET) NO EVIDENCE THAT ONE IS MORE EFFECTIVE NO EVIDENCE THAT ONE IS MORE EFFECTIVE

THAN THE OTHER – I USE SCRUBBINGTHAN THE OTHER – I USE SCRUBBING

FOR DEEP/DIRTY WOUNDS, MUST USE FOR DEEP/DIRTY WOUNDS, MUST USE HIGH PRESSURE IRRIGATION 500-1000 ccHIGH PRESSURE IRRIGATION 500-1000 cc

Wound CleansingWound Cleansing

Dilution is the solution to Dilution is the solution to pollutionpollution

High-pressure irrigation High-pressure irrigation significantly reduces infectionsignificantly reduces infection

Don’t put anything in a wound Don’t put anything in a wound you wouldn’t put in your eye you wouldn’t put in your eye (BETADYNE, H(BETADYNE, H220022))

Saline is the recommended Saline is the recommended irrigation liquid but tap water is irrigation liquid but tap water is sterile (in U.S.), much less sterile (in U.S.), much less expensive, and as effectiveexpensive, and as effective

CANYONS WOUND IRRIGATION SYSTEMCANYONS WOUND IRRIGATION SYSTEM

SKIN PREPARATIONSKIN PREPARATION

PREP SKIN WITH BETASEPT, NOT BETADYNEPREP SKIN WITH BETASEPT, NOT BETADYNE SIGNIFICANTLY BETTER ANTISEPTICSIGNIFICANTLY BETTER ANTISEPTIC LESS TOXIC TO WOUNDSLESS TOXIC TO WOUNDS PREP 2-3 INCHES MORE IN DIAMETER THAN PREP 2-3 INCHES MORE IN DIAMETER THAN

DRAPE FENESTRATION HOLE SIZEDRAPE FENESTRATION HOLE SIZE AFTER PREP, DRAPE WOUND AND DO MORE AFTER PREP, DRAPE WOUND AND DO MORE

THOROUGH DEBRIDEMENT, OFTEN SHARP WITH THOROUGH DEBRIDEMENT, OFTEN SHARP WITH SCALPEL OR SCISSORSSCALPEL OR SCISSORS

RE-IRRIGATE AFTER DEBRIDEMENTRE-IRRIGATE AFTER DEBRIDEMENT

TRIM WOUND EDGESTRIM WOUND EDGESIF WOUND EDGES ARE JAGGED, OF QUESTIONABLE IF WOUND EDGES ARE JAGGED, OF QUESTIONABLE VIABILITY, OR THE LACERATION IS NOT ORTHAGONAL TO VIABILITY, OR THE LACERATION IS NOT ORTHAGONAL TO THE SKIN EDGETHE SKIN EDGE USE A 15 BLADE TO MAKE AN EPIDERMAL INCISION, THEN USE A 15 BLADE TO MAKE AN EPIDERMAL INCISION, THEN

COMPLETE REMOVAL OF THE JAGGED WOUND EDGE COMPLETE REMOVAL OF THE JAGGED WOUND EDGE WITH SCISSORS (EASIER TO GET ORTHAGONAL CUT)WITH SCISSORS (EASIER TO GET ORTHAGONAL CUT)

DO NOT TRIM:DO NOT TRIM:• SCALP (INGROWN HAIRS)SCALP (INGROWN HAIRS)• EARS, EYEBROWS, EYELIDS AND LIPS (LOSS OF EARS, EYEBROWS, EYELIDS AND LIPS (LOSS OF

TISSUE – POOR COSMETIC RESULT)TISSUE – POOR COSMETIC RESULT)

DECISION TO DO PRIMARY CLOSURE DECISION TO DO PRIMARY CLOSURE OR DELAYED PRIMARY CLOSUREOR DELAYED PRIMARY CLOSURE

NEVER CLOSE A DIRTY WOUNDNEVER CLOSE A DIRTY WOUND FOR THESE WOUNDS DO DELAYED FOR THESE WOUNDS DO DELAYED

PRIMARY CLOSUREPRIMARY CLOSURE DO WET-TO-DRY DRESSING CHANGE DAILYDO WET-TO-DRY DRESSING CHANGE DAILY CLOSE THE WOUND IN 4 DAYSCLOSE THE WOUND IN 4 DAYS DO CLOSURE AS YOU WOULD A PRIMARY DO CLOSURE AS YOU WOULD A PRIMARY

CLOSURECLOSURE VERY LOW INCIDENCE OF INFECTIONVERY LOW INCIDENCE OF INFECTION SIMILAR COSMETIC RESULTSIMILAR COSMETIC RESULT

ANTIBIOTICS IN WOUND MANAGEMENTANTIBIOTICS IN WOUND MANAGEMENTPROPHYLACTIC ANTIBIOTICSPROPHYLACTIC ANTIBIOTICS

INDICATED FOR CAT, HUMAN, PRIMATE AND DOG INDICATED FOR CAT, HUMAN, PRIMATE AND DOG BITES; DIRTY WOUNDS OVER BURSAEBITES; DIRTY WOUNDS OVER BURSAE

SHOULD BE GIVEN FOR 48 HOURSSHOULD BE GIVEN FOR 48 HOURS MULTIPLE OPTIONSMULTIPLE OPTIONS

• AUGMENTIN 875 mg bid OR 500 mg tid X 2 DAYSAUGMENTIN 875 mg bid OR 500 mg tid X 2 DAYS• ROCEFIN 500 mg IM qd X 2 DAYSROCEFIN 500 mg IM qd X 2 DAYS• LEVOFLOXACIN 500 mg qd X 2 DAYSLEVOFLOXACIN 500 mg qd X 2 DAYS• ALL OF THESE ARE EFFECTIVE FOR P. ALL OF THESE ARE EFFECTIVE FOR P.

MULTOCIDA, E. CORRODENS, STAPH, STREPMULTOCIDA, E. CORRODENS, STAPH, STREP

INFECTED WOUNDSINFECTED WOUNDS

USUALLY >1 cm ERYTHEMA / WARMTH USUALLY >1 cm ERYTHEMA / WARMTH BEYOUND THE SKIN EDGEBEYOUND THE SKIN EDGE

IF WOUND SUTURED OR STAPLED, REMOVE IF WOUND SUTURED OR STAPLED, REMOVE ALL SUTURES AND/OR STAPLESALL SUTURES AND/OR STAPLES

IRRIGATE, DEBRIDE WOUND AND LOOK IRRIGATE, DEBRIDE WOUND AND LOOK FOR FOREIGN BODIESFOR FOREIGN BODIES

WET–TO–DRY DRESSING CHANGES DAILYWET–TO–DRY DRESSING CHANGES DAILY

ANTIBIOTICS FOR INFECTED WOUNDSANTIBIOTICS FOR INFECTED WOUNDS

ANTIBIOTICS: ANTIBIOTICS: BITE WOUNDS: UNASYN / AUGMENTIN; BITE WOUNDS: UNASYN / AUGMENTIN;

LEVAFLOXACINLEVAFLOXACIN OTHER INFECTED WOUNDSOTHER INFECTED WOUNDS

MUST BE CONCERNED RE: MRSA – IV MUST BE CONCERNED RE: MRSA – IV VANCOMYCIN, IV CLINDAMYCIN, ORAL VANCOMYCIN, IV CLINDAMYCIN, ORAL CLINDAMYCIN, SULFAMETHOXAZOLE CLINDAMYCIN, SULFAMETHOXAZOLE TRIMETHAPRIM +/- RIFAMPINTRIMETHAPRIM +/- RIFAMPIN

IF UNLIKELY TO BE MRSA: IF UNLIKELY TO BE MRSA: AUGMENTIN, LEVAQUINAUGMENTIN, LEVAQUIN

Wound Closure OptionsWound Closure Options

SuturesSutures StaplesStaples GlueGlue Steri-stripsSteri-strips Delayed primary closureDelayed primary closure Leave openLeave open

Basic PrinciplesBasic Principles Everted edges will result in Everted edges will result in

less scarringless scarring

Use the smallest suture Use the smallest suture needed to approximate the needed to approximate the edgesedges

Use small sutures placed Use small sutures placed closer together rather than closer together rather than large ones placed further large ones placed further apartapart

Approximate, don’t Approximate, don’t strangulate the edgesstrangulate the edges

Simple Interrupted StitchSimple Interrupted Stitch



Vertical Mattress StitchVertical Mattress Stitch



Used to evert tissue at Used to evert tissue at the wound edgesthe wound edges

Decreases tension at Decreases tension at the wound edgethe wound edge

Can be used in Can be used in combination with simple combination with simple

suturessutures toto assure assure eversioneversion

Horizontal Mattress StitchHorizontal Mattress Stitch

Horizontal Mattress StitchHorizontal Mattress Stitch

Corner StitchCorner Stitch

Corner StitchCorner Stitch

Running StitchRunning Stitch

Problem of Scar SpreadingProblem of Scar Spreading

Patients end up with ½ inch wide scars on legs, arms, Patients end up with ½ inch wide scars on legs, arms, trunktrunk

Takes 2 years for a wound to completely healTakes 2 years for a wound to completely heal Wound has 97% of it’s tensile strength in 6 monthsWound has 97% of it’s tensile strength in 6 months If put skin sutures in and take out in 1-2 weeks, the If put skin sutures in and take out in 1-2 weeks, the

wound pulls apart and is filled with scar tissue = wide wound pulls apart and is filled with scar tissue = wide scarscar

Can obviate this by using buried, interrupted, Can obviate this by using buried, interrupted, subcuticular suturessubcuticular sutures

Use PDS, Maxon – monofilament absorbable suturesUse PDS, Maxon – monofilament absorbable sutures These dissolve in 6 months and effectively prevent These dissolve in 6 months and effectively prevent

scar spreadingscar spreading

Buried Subcuticular StitchBuried Subcuticular Stitch

Buried Subcuticular StitchBuried Subcuticular Stitch

Problem of Scar SpreadingProblem of Scar Spreading

After closing with absorbable subcuticular After closing with absorbable subcuticular sutures, usually have a slight gap between the sutures, usually have a slight gap between the edges of epidermis edges of epidermis

Use steristrips, dermabond, or running 6-0 Use steristrips, dermabond, or running 6-0 monofilament sutures to close this gap.monofilament sutures to close this gap.

Advantages of subcuticular closure are:Advantages of subcuticular closure are: No scar spreadingNo scar spreading Can remove skin sutures in 4-5 days, rather Can remove skin sutures in 4-5 days, rather

than 7-14, this avoiding stitch marks than 7-14, this avoiding stitch marks

Subcuticular suturesSubcuticular sutures

Do not use a two-layer closure on:Do not use a two-layer closure on: ScalpScalp EarsEars Tip of noseTip of nose HandsHands FeetFeet

Increased incidence of infection with Increased incidence of infection with additional foreign body presentadditional foreign body present

Facial LacerationsFacial Lacerations

The face is unique – subcutaneous tissue The face is unique – subcutaneous tissue and muscle are attached to the skin (why we and muscle are attached to the skin (why we can wrinkle our foreheads, smile)can wrinkle our foreheads, smile)

If laceration through the muscle, close the If laceration through the muscle, close the muscle and subcutaneous tissue with 4-0 or muscle and subcutaneous tissue with 4-0 or 5-0 Vicryl or Polysorb (braided absorbable 5-0 Vicryl or Polysorb (braided absorbable sutures) – will prevent scar spreadingsutures) – will prevent scar spreading

Don’t need to use subcuticular sutures, only Don’t need to use subcuticular sutures, only subcutaneous suturessubcutaneous sutures

StaplesStaples

Usually used only for scalp lacerations in Usually used only for scalp lacerations in the EDthe ED

Recommended for linear wounds without Recommended for linear wounds without significant tensionsignificant tension

Except scalp, remove 2-3 days earlier Except scalp, remove 2-3 days earlier than sutures. Scalp – 7 daysthan sutures. Scalp – 7 days

Should be replaced with steristrips after Should be replaced with steristrips after removalremoval

GLUEGLUE(DERMABOND)(DERMABOND)

DRESSINGSDRESSINGS

PREVENT FOREIGN BODIES AND BACTERIA FROM PREVENT FOREIGN BODIES AND BACTERIA FROM ENTERING WOUNDENTERING WOUND

VANITYVANITY BACITRACIN, ADAPTIC, 4X4BACITRACIN, ADAPTIC, 4X4 KLING, KERLEX, TUBE GUAZE, TAPEKLING, KERLEX, TUBE GUAZE, TAPE KEEP ON AND KEEP DRY FOR 48 HOURS, THEN REMOVE, KEEP ON AND KEEP DRY FOR 48 HOURS, THEN REMOVE,

CHECK WOUND, BATHE CHECK WOUND, BATHE REDRESS OR LEAVE OPENREDRESS OR LEAVE OPEN CHANGE IF BLOOD SOAKS THROUGH DRESSING (GOOD CHANGE IF BLOOD SOAKS THROUGH DRESSING (GOOD

IDEA TO GIVE Pt MATERIAL FOR ONE DRESSING IDEA TO GIVE Pt MATERIAL FOR ONE DRESSING CHANGE AT DC)CHANGE AT DC)

SUTURE REMOVALSUTURE REMOVAL

SCALP – 7 DAYSSCALP – 7 DAYS FACE – 4-5 DAYS, THEN STERISTRIPFACE – 4-5 DAYS, THEN STERISTRIP UPPER EXTREMITIES – 7 DAYS, EXCEPT AREAS UPPER EXTREMITIES – 7 DAYS, EXCEPT AREAS

WHERE THERE IS EXCESS MOVEMENT (HANDS) WHERE THERE IS EXCESS MOVEMENT (HANDS) AND OVER EXTENSOR SURFACES (DIP, PIP, MCP, AND OVER EXTENSOR SURFACES (DIP, PIP, MCP, ELBOW) – 14 DAYSELBOW) – 14 DAYS

NECK, TRUNK – 10 DAYSNECK, TRUNK – 10 DAYS LOWER EXTREMITY – 12-14 DAYSLOWER EXTREMITY – 12-14 DAYS IF USE SUBCUTICULAR SUTURES – 3-4 DAYSIF USE SUBCUTICULAR SUTURES – 3-4 DAYS

Sharps SafetySharps Safety

Most likely time to get stuck is in your first Most likely time to get stuck is in your first three years of learningthree years of learning

1 million occupational needle sticks per 1 million occupational needle sticks per year in U.S. – much less now with safety year in U.S. – much less now with safety needlesneedles

Don’t hold the needle with your fingers!Don’t hold the needle with your fingers! Use forcepsUse forceps Always know where the needle is in your Always know where the needle is in your

fieldfield Dispose of all sharps after procedureDispose of all sharps after procedure

QUESTIONS?

Documents

WOUND MANAGEMENT M. Scott Linscott, MD University of Utah