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CLINICAL REVIEW: Steve J Mannion and Eddie Chaloner Principles of war surgery BMJ 2005; 330: 1498-1500 [Full text]

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Wound management

Barry Fearn   (24 June 2005)

Wound management 24 June 2005
Barry Fearn, Hon. Senior Orthopaedic Tutor Brighton BN3 3JP Send response to journal: Re: Wound management	Mannion and Chaloner have emphasised the importance of packing open a potentially contaminated wound. They have not added the important step of immobilising the soft tissues and, where possible, the joint above and below the wound, with a plaster-of Paris cylinder to prevent bacterial spread by movement in the tissue planes. This is useful, too, in multiple small superficial soft tissue puncture wounds. These may form localised small abscesses which can be drained easily at a later date. Most bacteria are sessile. When the tissues are immobilised in this way, systemic infection is avoided and local collections of pus can be drained when the dressing is changed first after 48 hours. The cast is retained until clean granulation tissue covers the entire exposed wound surface. The occlusive plaster technique was brought to this country by Professor Josep Trueta after the Spanish Civil War. Competing interests: None declared