Wound Care During Expeditions
Wounds are a common occurrence on expedition, and being able to manage a wide range of presentations is an important skill for an expedition medic to possess. In some climates, particularly tropical environments, wound healing can be delayed and there is an increased risk of skin breakdown and infection. It is therefore vital to know how to mitigate for this with items in your medical kit- however there are so many different dressings that it can often be hard to know which ones are most suitable for different wounds.
To start with it helps to consider what an "Ideal" dressing should be able to do and this table from the ABC of Wound Care. An ideal wound dressing should follow the mentioned characteristics as following:
control the moisture around wound,
great transmission of gases,
eliminate from excess exudates,
protect wound from infections and microorganisms,
decrease surface necrosis of wound,
have mechanical protection,
are easily changed and removed,
are biocompatible, biodegradable, elastic, and nontoxic,
relive the wound pain, and
costly acceptable.
Next it is important to appreciate what to look for when assessing a wound. Essentially it comes down to how much exudate is present- i.e. how wet or dry the wound is. Most of the time, an astute expedition medic should identify and appropriately manage a wound early on, aiming to be pro-active rather than reactive. The majority of wounds should not become necrotic. Whilst necrosis may occur with specific types of wounds such as snake bites or frostbite, apart form highlighting that such cases will usually need evacuation for specialist care, this article will not go into detail regarding the management of these conditions.
It is also important to remember that "primary dressings" cover a wound directly, whilst "secondary dressings" are used to hold a primary dressing in place. Bandages can then be used on top of the secondary dressings to protect the area if necessary.
Film dressings
Transparent adhesive film dressings are made of semipermeable membranes that are waterproof yet permeable to oxygen and water vapour. They maintain a moist wound environment and help prevent bacterial contamination. They are best for superficial wounds or wounds with light exudate. They can also be used to cover primary dressings that are not waterproof on their own.
Simple island dressings
Simple island dressings are usually used over wounds closed by primary intention, i.e. over a suture line or steristrips. These dressings have a central pad of cellulose material to absorb any oozing from the suture line during the first 24 hours post-surgery.
Non-adherent dressings
These dressings are designed not to stick to the drying secretions of the wound, thereby resulting in less pain and trauma on removal. This is important as on removal an adherent dressing can tear away any new granulation tissue within the wound bed.
Moist dressings
Moist dressings function by either preventing the skin surrounding the wound from losing moisture, or actively donating moisture to the area. Moist dressings can be divided into two groups: Hydrogel dressings and Hydrocolloid dressings.
Absorbent dressings
As the name suggests, these dressings are designed to absorb moisture and prevent maceration in wounds where there is lots of exudate present. Depending on their design, these may be used as either primary or secondary dressings.
One has to appreciate the complexities of this topic, but there are some basic principles that are always worth remembering:
How is the wound going to heal- primary or secondary intention?
How might this affect the type of dressing you will use?
What is the risk of the dressing adhering to the wound base?
How can you optimise the wound micro-environment?
What is the risk of infection?
What dressings do you have in your medical kit?
