Basic Suturing and Wound Management
Wound dressing
Dressings are
applied after suturing for several reasons. They shield the wound from
gross contamination, which is more or less important depending on the
patient's occupation. As well, a dressing can absorb blood and serous
material oozing from the wound, which serves to protect clothing and
bed linen. Finally, a dressing can improve patient comfort by
immobilizing injured tissue and avoiding further injury.
Although dressings can prevent gross contamination, it has been shown that wounds which remain covered for periods of greater than 48 hours without an inspection or change are more likely to become infected than wounds left open. After suturing a simple laceration, the patient should be instructed to change the dressing at 48 hours.
Dressing material should be clean, but does not necessarily have to be sterile. Most wounds are covered with a simple, light dressing prior to discharging the patient. If a layered dressing is required for the purpose of greater absorption or application of pressure or splinting, then the first layer should be a non-adherent material such as Vaseline gauze.
Subsequent layers can include absorptive gauze and a pressure pad, if desired.
The final layer should be a Kling™ wrap or elastic bandage to secure the dressing and apply pressure as needed.
Bulky pressure dressings serve to reduce wound drainage and deter hematoma formation, which can increase the potential for infection. As well, they can improve patient comfort by splinting the wound and by supporting the surrounding tissues and may reduce the risk of dehiscence.
Wet dressings should be changed immediately and dirty dressings should be changed as often as 12-24 hours.
Many patients will ask when they can get the sutured wound wet. A clean minor wound can be immersed for brief periods after 48 hours. This allows them to bathe, shower and even swim. The patient should be cautioned against prolonged immersion, as this tends to break down the wound.
Although dressings can prevent gross contamination, it has been shown that wounds which remain covered for periods of greater than 48 hours without an inspection or change are more likely to become infected than wounds left open. After suturing a simple laceration, the patient should be instructed to change the dressing at 48 hours.
Dressing material should be clean, but does not necessarily have to be sterile. Most wounds are covered with a simple, light dressing prior to discharging the patient. If a layered dressing is required for the purpose of greater absorption or application of pressure or splinting, then the first layer should be a non-adherent material such as Vaseline gauze.
Subsequent layers can include absorptive gauze and a pressure pad, if desired.
The final layer should be a Kling™ wrap or elastic bandage to secure the dressing and apply pressure as needed.
Bulky pressure dressings serve to reduce wound drainage and deter hematoma formation, which can increase the potential for infection. As well, they can improve patient comfort by splinting the wound and by supporting the surrounding tissues and may reduce the risk of dehiscence.
Wet dressings should be changed immediately and dirty dressings should be changed as often as 12-24 hours.
Many patients will ask when they can get the sutured wound wet. A clean minor wound can be immersed for brief periods after 48 hours. This allows them to bathe, shower and even swim. The patient should be cautioned against prolonged immersion, as this tends to break down the wound.