Dressing of purulent wounds

Condition assessment and wound toilet

The first step of a dressing change is always a visual inspection and assessment of the discharge. The physician must determine the nature of the exudate, as it can vary widely. Fresh blood, collections of pus, serous fluid, or in specific cases, intestinal contents or bile may be found in the wound.

Following the assessment, removal of this discharge begins. This manipulation is performed by gently drying the surface using sterile gauze balls or sponges. This prepares the tissues for subsequent exposure to antiseptic solutions.

Wound irrigation and surgical debridement

The cavity, now cleared of surface exudate, must be thoroughly washed. Various antiseptics are used for this purpose, although a 3% hydrogen peroxide solution is considered the optimal choice.

Irrigation technique:

1. The antiseptic is delivered into the cavity under pressure — as a directed jet from a syringe.
2. After complete irrigation, the tissues are dried by careful blotting.

This is followed by the debridement stage. Using forceps or through intensive flushing, the physician removes various pathological elements:

• bone sequestra;
• detached necrotic tissues;
• fibrinous deposits;
• purulent plugs;
• potential foreign bodies.

If firmly fixed necrotic tissues are found in the wound, they must not be left behind — in such situations, surgical necrectomy is indicated.

Drainage and packing: goals and types

Drainage or packing of the wound tract is used according to strict indications, which include the retention of purulent discharge in tissues or the onset of secondary hemorrhage.

Main goals of the procedure:

• Ensuring a constant outflow of exudate and pus.
• Reliable hemostasis.
• Local antisepsis and maintenance of debridement results.

The choice of material directly depends on the planned duration of drainage:

• Gauze packs: their drainage properties are extremely limited and persist for only a few hours.
• Tubular drains: made of rubber or polyvinyl chloride. They are intended for long-term drainage. A mandatory requirement for such tubes is the presence of additional side holes to improve outflow.

Drain management techniques and tactics

During a routine dressing change, the physician must assess the position of the placed drains or packs and how well they are functioning. If the system is clogged or soaked, it is replaced. If the function of the drain is fully completed, it is removed.

Step-by-step technique for inserting a new drain:

1. Performing a wound toilet.
2. Thorough preparation of the surrounding skin.
3. Insertion of the drainage tube or pack using forceps or a clamp.
4. Reliable fixation of the drain with a strip of adhesive plaster (choosing the most advantageous position to ensure gravity-dependent outflow).
5. Application of the final protective dressing.

Class and exam questions

What else to study on this topic

• Nature of wound discharge: features of bile, intestinal contents, and serous fluid
• Technique for removing bone sequestra and fibrinous deposits
• Choosing between rubber and polyvinyl chloride tubular drains
• Assessment of drain function and indications for removal
• Technique for fixing a drainage tube with adhesive plaster in an advantageous position

Other topics in "CHAPTER 10. GENERAL ISSUES IN TRAUMATOLOGY"

Prepared by WhiteCoat Pro faculty in accordance with the medical school curriculum. For educational purposes only.