never mind
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Senior Member
never mind
Last edited by Hmac; 09-10-12 at 16:15.
Member
You mean suturing a wound after being open 4-5 days is common?? Says who? If someone walks in off the street with a wound that has been open for the many days there is no way I would suture that closed. This is coming from an ER stand point. Post-op surgical situations are different.Originally Posted by Hmac
I would also not put sugar in a wound.
Last edited by jknopp44; 09-10-12 at 17:08.
Senior Member
Delayed closure of a clean, granulating wound is acceptable. Certainly that would likely be a planned event, which is where you're probably confused - a patient comes in with a grossly contaminated wound, you clean it out, debride it, then once it begins to granulate after about 4 days, he comes back and you close it. You're thinking of a patient wandering into the ER off the street with an open wound of indeterminate age. Yes, you're right. You wouldn't close that, you'd let it heal by secondary intention.
Member
I still have never seen that performed in an ER setting. Do you mean in a surgeons office? I cannot think of when I have ever seen this approach taken. Not trying to be argumentative just never seen that approach done. Have you? If so, I would be interested in the circumstances. There are indeed instances where if a physician is closely following the patient then delayed closure can take place but this HAS to be closely monitored. I am a Board Certified Emergency Room physician so I know a thing or two about wound care.
We have to be careful about giving people the idea that if they keep a wound carefully cleaned they can close it at a later day several days down the road. Therefore I would say that it is NOT common at all to close wounds that have been open for several days.
Last edited by jknopp44; 09-10-12 at 18:32.
Member
Sugar has some minor natural anti bacterial properties which is why it is still used as a preservation aid; problem is that it kills good things too and isn't as effective as other options (like keeping it clean or visiting a MD). I wouldn't want it packed in a wound of mine other than as a last resort.
Tapatalk ate my spelling and grammar.
Senior Member
No, this wouldn't likely be something you would see in the ER. It would be a wound that you originally saw, then decided to either pack open, or called a surgeon to consult and he decided to pack open. Then return to the surgeon to either continue packing, or close if it was clean and granulating.I still have never seen that performed in an ER setting. Do you mean in a surgeons office? I cannot think of when I have ever seen this approach taken. Not trying to be argumentative just never seen that approach done. Have you? If so, I would be interested in the circumstances. There are indeed instances where if a physician is closely following the patient then delayed closure can take place but this HAS to be closely monitored. I am a Board Certified Emergency Room physician so I know a thing or two about wound care.
We have to be careful about giving people the idea that if they keep a wound carefully cleaned they can close it at a later day several days down the road. Therefore I would say that it is NOT common at all to close wounds that have been open for several days.
I acknowledge your expertise in dealing with acute wounds. As a General Surgeon, I'd be the guy you'd have those more complicated wound patients follow up with, or maybe the guy you'd call if the wound exceeded your training or experience, or needed to go to the OR for debridement and definitive management.
Last edited by Hmac; 09-11-12 at 07:20.
Member
Ahh yes. My General Surgery collegues are the true experts at wound care. I have seen you all take care of some nasty chronic wounds with great outcomes. The problem I face is actually getting these people to follow up with you and keep their appointments.
Senior Member
Seconding the "delayed closure is done" comments. I'm more an ER background, but even as a med student I've seen some wounds up to several months of age closed up ... mainly big laparotomies that remained open and under a wound-vac. The wounds eventually healed by granulation enough to close. Obviously those were getting very close attention and were not a knee-jerk closure.
Member
This is exactly how I was treated after my appendix operation. The wound healed from the inside out and took several weeks. The opening was 3-4 inches long, about a quarter inch wide, and deep enough to get to my appendix.
Apparent to me is a lack of clarity on why one would forgo usual medical protocols.. This discussion is clearly not intended for the present state of available medical care, nor the litigious environment of current US "medicine".
If in an austere environment, rapid definitive lasting treatment is needed. Facing extremely limited resources, minimal time with a medically trained person & likely won't have a chance to do a "follow up" in any method understood in a 1st world benign setting.. if at all.
Additionally, minimizing ones activities post tx is seldom an option in this. Clean, debride, prophylaxis(if available), seal wound, kick out the door.
SUTURES ARE GOOD.
if you don't understand anatomy deep layered sutures to the surface close may be a stretch. But it's certainly not rocket science. The body is amazingly resilient if you give it a chance.
I've trained and used illiterate medics to good effect. A literate educated person with the right guidance / books can do fine.
Based on couple decades+ of 3rd world experiences, in proximity to loud noises, with minimal resources.
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