Wound care following injuries (accidents)

An open wound caused by an accident and surrounded by a bruised skin area may, consequently, be difficult to heal. In most cases there is local damage to the vessels that supply blood to the soft tissue. This means that wound healing may be delayed owing to the fact that a reduction in circulation brings about reduced local oxygen saturation and impedes transport of the necessary wound healing components. If the injury is further aggravated by a bone fracture under the bruised skin area, healing of the bone fracture may, depending on the extent of the accident-related vascular damage, also be adversely impaired.

Treatment of accident-related wounds

The primary objectives are to protect the damaged soft tissues as much as possible and to limit further accident-related consequences. Countermeasures must be taken against potential contamination of the wound with bacteria, which are always present on the skin and may enter the wound via external factors (such as dirt from the street). The wound must first be gently but thoroughly cleaned with a sterile rinsing fluid and finally rinsed out with a soft tissue-friendly liquid disinfectant. If the wound is large in size and shows irregular lacerated edges, then exploration and treatment of the wound should take place in the operating theatre. This provides the sterile conditions necessary for wound exploration, and, if necessary, the wound can be further opened for exploration.

Special procedure for treating accident-related wounds and bone inflammation

Considerable progress was made in the treatment of accident-related wounds with the introduction of the technique known as negative pressure wound therapy. Before this technique was available or could be introduced, the standard procedure for surgical wound exploration comprised cleaning, application of a disinfectant rinsing agent and, finally, a sterile dressing. The inherent advantage of negative pressure wound therapy is that a traumatic wound, which is normally dressed with a semi-open dressing, is transformed by this system into a semi-closed dressing. One or more sponges, depending on the size of the wound, are inserted into the wound, which is then sealed with a film that is semi-permeable to water vapour. A suction cup connects the film to a pump which creates a vacuum in the wound. This maintains the sterility of the wound by sealing it off from the environment. The negative pressure thus generated causes excess tissue fluid to be drawn off by suction and stimulates local blood circulation to the wound. As a consequence, wound healing can be set in motion and the risk of soft tissue or bone inflammation substantially reduced.

Negative pressure wound therapy with instillation (wound treatment and its further development)

The Department of Traumatology at the University Hospital Zurich is one of the institutions most responsible for research leading to the further development of an innovative form of negative pressure wound therapy. This is known as negative pressure wound therapy with instillation. When this technique is applied, the sponges that are placed in the wound are regularly rinsed during the day with a disinfectant liquid (such as a diluted polyhexanide solution). This provides an effective means of treating wound infections or bone inflammation. The benefit of this technique is that it reduces the time it takes to treat (infected) wounds or bone inflammation and decisively lowers the risk that such inflammation will reoccur.

Accident-related wounds with skin defects

If an accident results in a soft tissue defect that prevents a wound from being closed, various additional treatment options are available whereby the soft tissue defect can be closed. Very often, the negative pressure dressing technique is applied first to reduce the risk of an (additional) infection as already mentioned. This is followed by an assessment of how skin closure can be achieved. In the majority of cases, for example, this can be achieved by means of a skin graft, wherein skin is taken from an uninjured location on the patient’s own body. Some adverse effects of this technique are the sub-optimal formation of scar tissue that sometimes occurs and the reduction of sensation that normally occurs in the transplanted skin, which, moreover, is more vulnerable to new wounds and tears. To counteract such adverse results, the Department of Traumatology at the University Hospital Zurich uses bioresorbable skin reinforcement products during surgical skin graft procedures to achieve a treatment result that is optimal both cosmetically and functionally in everyday life.

If it is not possible to close accident-related soft tissue injuries by these procedures, we have other, more costly options at our disposal, including, for example, muscle flap grafts.