The general practitioner is the first line of care
Proper management of limb wounds
By: María Gabriela Gómez S.
Wounds, cuts, or bruises on extremities can become a serious labor problem due to its high incidence of complications. True functional disasters come from this most of the time due to bad handling since the beginning, consequence of the attitude called “the compulsion of closing wounds”, according to manual limb injuries, of Surgical Urgency, from the University of Valle, Cali, Colombia.
The doctor is conditioned psychically and environmentally to act compulsively before any wound, considering that it must be closed, without worrying a lot of other factors, like the type of injury, the elapsed time, the grade of contamination and the most serious, the lack of a suitable debridement. A daily example of this compulsion is the primary closure of wounds by firearm and by animal bites, closure that is a frank invitation to disaster, to infection and irreversible deformities. It has been shown that the healing of an already contaminated wound would be better if the closure of it is deferred 3-5 days after the initial injury and its contamination happens.
The exposure of the wound, from bones and tendons for 3-5 days, does not seem to be detrimental to these structures, concluding that what is important in the management of the wounds is not to suppress bacteria, but suppress its proliferation and let the well-vitalized tissues defend on their own.
The general practitioner who is first line of primary care of wounds, is the key element to finish with the fear of compulsion in closing wounds. It is important to become aware of the importance of the role of the specialist in front to wounds, especially those on hand.
The wounds are classified into two large groups:
Cutting clean wounds:
Are those produced by sharp instruments (knife, glass). If they arrive within the first 4 hours of production they are considered clean; otherwise, they are contaminated. Many times they can injure important structures (tendons, nerves, joints, vessels).
Blunt dirty wounds:
These wounds are those that have suffered injuries by crushing, explosion, firearms, burns, bites with considerable damage of several tissues, or great contamination by strange antibodies. There is great vascular compromise that will produce thrombosis and tissue necrosis, the initial evaluation of this type of injury can be very difficult, the same as the decision to remove or resect primarily