Intended for healthcare professionals

Practice ABC of wound healing


BMJ 2006; 332 doi: (Published 06 April 2006) Cite this as: BMJ 2006;332:838
  1. Brendan Healy1,
  2. Andrew Freedman
  1. 1 Brendan Healy is specialist registrar in infection diseases and microbiology, and Andrew Freedman is honorary consultant in infectious diseases at University Hospital of Wales, Cardiff.

    Despite optimal treatment some wounds are slow to heal. The challenge clinically and microbiologically is to identify those wounds in which healing is impaired as a result of infection or heavy bacterial burden and in which systemic or topical antimicrobial treatment will be of benefit.

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    A charcoal swab preserves bacteria during transport to the laboratory

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    Management of bite wounds

    Staphylococci and streptococci are the most commonly encountered pathogenic organisms in community acquired superficial wounds. More unusual organisms may be found in bite wounds, and these reflect the source of the bite. Pathogenic organisms causing surgical wound infections vary according to the anatomical site of surgery. Antibiotic resistant organisms, such as methicillin resistant Staphylococcus aureus (MRSA), are more commonly encountered, reflecting the hospital flora.

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    Punch biopsy for microbiological analysis

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    Signs of wound infection

    When to sample

    It is inappropriate to swab all wounds: swabs should be taken only from overtly infected wounds and from wounds that are deteriorating, increasing in size, or failing to make satisfactory progress despite an optimal environment for wound healing. Indicators of wound infection include redness, swelling, purulent exudate, smell, pain, and systemic illness in the absence of other foci. Subtle signs of local wound infection include unhealthy “foamy” granulation tissue, contact bleeding, tissue breakdown, and epithelial bridging. Staphylococcus aureus

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    Semiquantitative analysis of swab showing light or scanty, moderate, and heavy growth of Staphylococcus aureus

    Types of sample

    Superficial wound swabs—The ease of obtaining and processing superficial wound swabs, combined with their relatively low cost and non-invasive nature, make them in most instances the most appropriate method for wound sampling. Organisms cultured from a superficial swab may, however, simply reflect the colonising bacterial flora and are not always representative of the pathogenic organisms invading deeper tissue. This is particularly relevant to deep surgical and deep penetrating wounds in which infection from internal …

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