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INTRODUCTION

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After an acute wound is repaired, focus subsequent wound care to optimize healing and prevent complications. Issues to consider include the appropriate use of dressings, efforts to minimize edema, prophylactic antibiotics, tetanus prophylaxis, cleansing, and use of packing or drains. Provide patients with appropriate pain control, follow-up instructions, and patient education.

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USE OF DRESSINGS

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Wound dressings provide a moist environment to promote epithelialization and speed healing. Cover appropriate sutured or stapled wounds with a protective, nonadherent dressing for 24 to 48 hours. Semipermeable films such as OpSite® are available as an alternative to conventional gauze dressings, although one of the disadvantages of these newer materials is their inability to absorb large amounts of fluid. As an alternative to traditional dressings, topical antibiotics may be used to facilitate a warm, moist environment to promote initial wound healing and may help to prevent scab formation. Wounds closed with tissue adhesives should not be treated with topical antibiotic ointment because it will loosen the adhesive and may result in wound dehiscence.

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PATIENT POSITIONING AFTER WOUND REPAIR

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Recommend elevation of the injured body part, if possible, to reduce edema around the wound and facilitate healing. Splints can be useful for extremity injuries as they decrease motion across the wound and may help limit movement-associated discomfort or the development of additional edema. Pressure dressings can be used in some circumstances to help minimize the accumulation of fluid and are useful for ear and scalp lacerations (see Chapter 11).

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PROPHYLACTIC ANTIBIOTICS

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Prophylactic antibiotics are not routinely recommended for all wounds, but instead should be reserved for selected special circumstances. When deciding whether or not to prescribe antibiotics, consider the mechanism of injury, location of the wound, degree of any bacterial or soil contamination, and host factors that may predispose to infection.

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Prophylactic antibiotics are often recommended for human bites, dog or cat bites on the extremities (see Chapter 15), open fractures, and wounds with exposed joints or tendons (see Chapters 12 and 13). Patients with wounds in areas with lymphedema may also benefit from prophylactic antibiotics. When indicated, a 3- to 5-day course of antibiotics is adequate for nonbite injuries and a 5- to 7-day course is adequate for bite wounds. See Table 16-1 for recommended antibiotic regimens for those special circumstances when antibiotics may be indicated. Patients at high risk for infection should be advised to return for a wound check in 24 to 48 hours.

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Table 16-1

Postrepair Oral Antibiotic Prophylaxis

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