Acute Wound Management

Acute Wound Management

Acute wound management is an effort to get optimal wound healing, prevent infection, and overcome pain due to the wound caused.

Acute injury is damage to skin tissue or tissue continuity due to trauma or surgery. The pathoetiology of acute injury or traumatic injury is the mechanism, pattern, location, energy delivered and tissue damage, as well as the severity of contamination from the wound.

Acute wound care such as trauma wounds have different management from chronic wound care such as pressure injury, diabetic ulcer, venous ulcer, to malignant wounds.

In accordance with the reference to the triangle of wound assessment issued since 2016 by the World Union of Wound Healing Societies (WUWHS), wound assessment must be carried out holistically to obtain optimal wound healing Wound identification is carried out as an initial assessment, things that need to be assessed are the nature of the wound worsening, static, healing wounds or acute injuries.

Then to get an optimal wound, further assessment is carried out to prepare the wound bed. The base of the wound, the edge of the wound and the skin around the wound should be assessed.

The following is a basic assessment of injuries that can be assessed, includi

• Wound base: assessment of vital and non-vital tissues, exudate management, managing bacterial burden, rehydration of the wound floor, and protecting granulation/epithelialization tissue
• Wound edges: exudate management, keeping wound edges moist, removing non-vital tissue, protecting granulation/epithelialization tissue
• Skin around wounds: exudate management, skin rehydration, non-vital tissue removal, skin protection

In carrying out acute wound management considered the use of antibiotics, tetanus prophylaxis, the need for surgery, debridement and stabilization of fractures (in conditions of open fractures) and wound closure.

Wound closure can be done according to the condition of the wound. Clean and uncontaminated acute wounds can be closed primaryly, while contaminated and infected wounds can be closed secondarily. In addition, based on existing studies, honey is effective for treating wounds.

This wound management action can also lead to early and advanced complications, such as hematomas, infections, scar formation, and keloids. Patients should be able to take good care of wounds while at home and follow up according to doctor's directions.

Acute wound management techniques begin with wound identification, wound irrigation and debridement, anesthesia, wound suturing, and wound care. In preparation for wound management, it is necessary to identify factors that can affect wound healing and the risk of infection. Check whether the patient has comorbid diseases such as diabetes, anemia, or immunocompromise. In addition, conduct an examination of the wound. Ask about the history of the mechanism of occurrence of injuries, location, time of occurrence. Identify possible contamination or infection.

Provide education during acute wound closure. In dirty wounds with an unknown history of tetanus vaccination, the patient will be recommended for tetanus vaccine. In animal bites, rabies prophylaxis can be administered.

Several acute wound management measures need to be considered before, during, and after wound closure.

• Anamnesis and physical examination are needed to assess and determine the type of wound management measures (primary, secondary, or delayed primary closure) and the type of wound closure
• Each wound needs to be irrigated before wound closure to prevent infection. Use normal liquid saline or clean water for irrigation of at least 250 ml
• Local anesthetic closure is usually given prior to suturing. However, in some cases, anesthesia may be given at the time of debridement to reduce pain during irrigation and debridement of the wound.

Wound care is now increasingly advanced in Indonesia, especially in Bali, there are many clinics or facilities that provide wound care with modern wound care methods. So patients do not need to bother coming to the hospital to do wound care, there are many facilities that provide home service services that can be contacted at any time.