Traumatic and surgical woundsBMJ 2006; 332 doi: https://doi.org/10.1136/bmj.332.7540.532 (Published 02 March 2006) Cite this as: BMJ 2006;332:532
- David J Leaper, visiting professor of surgery
- At the Wound Healing Research Unit Cardiff University, Cardiff.
Management of traumatic and surgical wounds has had a chequered history. For example, in 1346 at the Battle of Crécy, France, foot soldiers were issued with cobwebs to staunch haemorrhage caused by trauma. Two centuries later, the eminent surgeon Ambroise Paré (1510-1590) rejected boiling oil as a primary dressing after amputation, preferring a mixture of oil of turpentine, rosewater, and egg.
Surgical incisions—Surgical incisions cause minimal tissue damage. They are made with precision in an environment where aseptic and antiseptic techniques reduce the risk of infection, with the best of instruments and the facility to control haemostasis. Penetrating trauma may involve minimal damage to skin and connective tissue, though deeper damage to vessels, nerves, and internal organs may occur.
Lacerations—Lacerations are caused when trauma exceeds intrinsic tissue strength—for example, skin torn by blunt injury over a bony prominence such as the scalp. Tissue damage may not be extensive, and primary suturing (see below) may be possible. Sterile skin closure strips may be appropriate in some circumstances—for example, in pretibial laceration, as suturing causes increased tissue tension, with the swelling of early healing and inflammation leading to more tissue loss.
Contusions—Contusions are caused by more extensive tissue trauma after severe blunt or blast trauma. The overlying skin may seem to be intact but later become non-viable. Large haematomas under skin or in muscle may coexist; if they are superficial and fluctuant they can be evacuated with overlying necrosed skin. Ultrasound scanning or magnetic resonance imaging may help to define a haematoma amenable to evacuation. Extensive contusion may lead to infection (antibiotic prophylaxis …