The World Health Organization (WHO) lists what it considers to be the essentials for wound care worldwide (Table 25-1), varying with four levels of hospital capabilities (described in Table 5-1).
++ Table Graphic Jump Location TABLE 25-1WHO Wound Treatment Essentials ||Download (.pdf) TABLE 25-1 WHO Wound Treatment Essentials
| ||Facility Level |
|Resources/Capabilities ||Basic ||GP ||Specialist ||Tertiary |
|Assess wounds for potential death and disability ||E ||E ||E ||E |
|Nonoperative management: clean and dress ||E ||E ||E ||E |
|Tetanus prophylaxis (toxoid, antiserum) ||D ||E ||E ||E |
|Minor surgical—cleaning and suturing ||PR ||E ||E ||E |
|Major surgical—debridement and repair ||I ||PR ||E ||E |
Optimal wound care requires an inspection for deep structure injury and foreign bodies. A dry field, without bleeding, is usually necessary. For wounds on a finger or toe, the best method is to apply a large venous tourniquet tightened around the base of the finger or toe and secured with a large clamp (Fig. 25-1). No one will forget that they have a hemostat attached to their hand. The old “rubber band” tourniquets are generally not a good idea, because they are easy to inadvertently leave on after the procedure is complete.
Safe method of applying tourniquet to finger.
Make another type of digital tourniquet by cutting the finger off a surgical glove and putting it on the finger to be sutured—or putting the entire glove on the patient’s hand. Then cut a small hole at the top and roll the rubber down to the finger or toe’s base and, voilà, a dry field in which to explore and suture the laceration or remove part of the toenail (Fig. 25-2). It is safer if you leave the entire glove on the hand so that no one forgets the tourniquet is there. The cut-off glove finger alone works well on a toe, especially the hallux of an ingrown nail needs to be removed.
A finger tourniquet made by rolling a glove’s finger or finger cot down the digit.
While large pressure dressings, tourniquets, and vessel ligation can all stop bleeding from a wound, an elegant and easily improvised pyramid dressing can often stop significant bleeding using fewer resources. Once you identify a briskly bleeding area—often from a relatively small wound—occlude it with finger pressure. Then replace the finger with a tightly folded “nugget” of gauze held firmly on the spot. If the positioning is ...