Wound care involves cleaning, closing, and protecting injuries to the skin to prevent infection and promote optimal healing. The type and depth of wound determine management.
Wound Assessment
Determine the mechanism (sharp object, blunt trauma, crush, abrasion, puncture, bite). Assess depth: superficial (epidermis only, no bleeding), partial-thickness (dermis, bleeding), and full-thickness (through dermis into subcutaneous tissue). Assess for foreign bodies and contamination. Check for underlying injury (tendon, nerve, vascular damage). Assess bleeding: most wounds stop bleeding with direct pressure; active arterial bleeding requires urgent control.
Bleeding Control
Apply direct pressure with a clean cloth or gauze. Maintain continuous pressure for 10–15 minutes. Do not lift the dressing to check — this disrupts clot formation. If blood soaks through, add more dressing on top. For severe, life-threatening bleeding, a tourniquet may be applied proximal to the wound. Tourniquet use is appropriate for amputations, multiple injuries, or when direct pressure fails. Note the time of application. Once applied, leave the tourniquet in place until professional care is available.
Cleaning the Wound
Irrigate with clean running water or saline. Wound irrigation is the single most important step in preventing infection. Use moderate pressure (a syringe with a catheter tip). Remove visible debris with clean tweezers. Clean the surrounding skin with soap and water, avoiding the wound itself. Antiseptics (hydrogen peroxide, alcohol, iodine) should not be used in open wounds — they damage healthy tissue.
Wound Closure
Small, clean, superficial wounds can be left open to heal by secondary intention. Apply a thin layer of antibiotic ointment (bacitracin, Neosporin) and cover with a sterile dressing. Change the dressing daily and keep the wound clean and dry. Larger or deeper wounds may require closure with sutures, staples, or adhesive strips (Steri-Strips). Wounds that require medical evaluation for closure: deep wounds (through the dermis), wounds with visible fat, muscle, or bone, wounds on the face or hands, jagged wounds, wounds caused by animal or human bites, and wounds with foreign bodies.
Signs of Infection
Pain (increasing after initial improvement), redness (spreading from the wound margin), swelling, warmth, purulent drainage, fever, and red streaks extending from the wound (lymphangitis). Wound infection requires medical evaluation — oral antibiotics and possible wound drainage. Tetanus prophylaxis: a tetanus booster is recommended if the wound is dirty or contaminated and the last booster was more than 5 years ago, or for any wound more than 10 years since the last booster.
Special Wound Types
Puncture wounds. Small entry wound but deep inoculation of bacteria. High risk of infection, especially if caused by nails through shoes. Clean thoroughly, leave open (do not close), and monitor closely.
Abrasions (scrapes). Superficial loss of epidermis. Clean thoroughly, apply antibiotic ointment, and cover with non-stick dressing.
Avulsions. Tissue torn away partially or completely. Preserve avulsed tissue (wrap in clean gauze, place in sealed plastic bag, keep cool on ice — but do not freeze) and seek emergency care.
Bites. Animal and human bites carry high infection risk. Copious irrigation is essential. Bite wounds on the face, hands, or in immunocompromised patients require antibiotics. Rabies prophylaxis for unvaccinated or wild animal bites. Cat bites have the highest infection rate.
Summary
Wound care starts with thorough cleaning. Direct pressure controls most bleeding. Small superficial wounds heal well with cleaning, antibiotic ointment, and sterile dressing. Deep, contaminated, or high-risk wounds require medical evaluation. Monitor for signs of infection. Tetanus prophylaxis should be updated as needed. Bite wounds have special infection risk.