Examining and cleaning a wound before closing

Attention

• All dirt, gravel, sand must be taken out of wound before suturing so it heals properly and doesn’t get infected
• If there is a chance that foreign body could still be in — send for further examination before closing
• Giving antibiotics is not a substitute for proper cleaning of wounds
• Immunisation status — tetanus

What you need

• Hair clippers
• Sterile dressing pack
• Normal saline for cleaning
• 20mL syringe and 19G needle
• Sterile scissors with pointed ends
• Extra sterile gauze
• 2 pairs sterile gloves (new non-sterile gloves if sterile not available)

What you do

Examine

• Check sensory and motor nerve response before giving local anaesthetic + adrenaline (epinephrine) if wound actively bleeding
• Do not use local anaesthetic + adrenaline (epinephrine) for fingers, toes, penis, nose, ears
• Look carefully, explore wound and surrounding area for
• Colour, warmth, sensation, movement, swelling
• Size and shape
• Clean, dirty (eg soil, glass)
• Nerve injury
• Damage to major blood vessels
• Tendon injury
• Deep muscle damage
• Bone or joint involvement

Clean

• Procedure may be painful — Give local anaesthetic if needed before cleaning wound
• Clean site and drape with sterile towels
• Use forceps in pack to take out any dirt or debris in and around wound
• Flush wound with 500mL normal saline to wash out (irrigate) wound — use pressure to remove any visible dirt (contaminants)
• If dirty wound — use 20mL syringe and 19G needle to flush with antiseptic (eg povidone-iodine, chlorhexidine) before closing
• May need to use more than 20mL antiseptic
• If chronic wound — consider specialised wound cleanser
• Put in a gloved finger into the wound to feel for deeper damage and foreign body
• Trim any torn skin edges with sterile scissors — only remove tissue/skin that you think is so badly damaged that it won’t survive. Take off as little skin as possible
• Trim hair around wound if needed. Do not trim eyebrows (they may not grow back)