Wounds ====== þ Plantar Puncture Wounds IV. Plantar Puncture Wounds A. Rate of infection 2-10% a. Increased Pseudomonas if sweaty sneakers B. No evidence of benefit with prophylactic antibiotics C. Cleansing alone sufficient D. R/O Foreign body a. X-ray for radio opaque b. CT or US for non radio opaque E. No evidence to support wound coring or high pressure irrigation F. Cipro or Dicloxacillin for immune compromised or sweaty shoe Singer AJ, Dagum AB. Current Management of Acute Cutaneous Wounds. N Engl Jour Med. 2008;359:1037-46. þ Mammalian Bites A. Rate of infection a. 3-18% for Dog bites (open lacerations) b. 28-80% for Cat bites (punctures) B. Evidence suggests safe to close most bites after high pressure irrigation a. Exceptions: Puncture wounds C. Delayed primary closure may be considered for large heavily contaminated wounds D. "Fight bites" should not be closed E. Antibiotics only decrease infection rate for: a. Hand Bites b. Human Bites þ Cap and Mask? Cap and mask doesn't make any difference [get ref] Ruthman, J. C., D. Hendricksen, et al. (1984). "Effect of cap and mask on infection rates in wounds sutured in the emergency department." IMJ Ill Med J 165(6): 397-9. [Adam Singer, SUNY Stonybrook] þ Sterile Gloves? - Standard box gloves as good as sterile gloves for wound repair. [Perelman VS, Francis GJ, Rutledge T, Foote J, Martino F, Dranitsaris G. Sterile versus nonsterile gloves for repair of uncomplicated lacerations in the emergency department: a randomized controlled trial. Ann Emerg Med 2004;43(3):362-70.] Abstract: But may have had selection bias, leaving out high-risk wounds. þ Golden 8 hours? Berk at all Ann 1988 17:496: Head and neck healed even if after 19 hours Trunk>Arms>Legs worse healing Even if 24 hours, face OK in kids; Berk, W. A., D. D. Osbourne, et al. (1988). "Evaluation of the 'golden period' for wound repair: 204 cases from a Third World emergency department." Ann Emerg Med 17(5): 496-500. Uncertainty about the existence and duration of a "golden period" for suture repair of simple wounds led us to evaluate prospectively the consequences of delayed primary closure on wound healing. Wounds were eligible for study if they were not grossly infected, and had no associated injuries to nerves, blood vessels, tendons, or bone. Three hundred seventy-two patients underwent suture repair; 204 (54.8%) returned for review seven days later. The mean time from wounding to repair for all patients was 24.2 +/- 18.8 hours. Wounds closed at up to 19 hours after wounding had a significantly higher rate of healing than those closed later: 82 of 89 (92.1%) compared with 89 of 115 (77.4%) (P less than .01). Of 23 wounds sutured 48 or more hours (mean, 65.3) after wounding, 18 (78.3%) were healing at follow-up. In contrast to wounds involving other body areas, the healing of head wounds was virtually independent of time from injury to repair: 42 of 44 (95.5%) wounds involving the head and repaired later than 19 hours after injury were healing, compared with 47 of 71 (66.2%) of all other wounds (P less than .001). On the basis of these data we conclude that there is a 19-hour "golden period" for repair of simple wounds involving body areas other than the head, after which sutured wounds are significantly less likely to heal, and the healing of clean, simple wounds involving the head is unaffected by the interval between injury and repair. þ Wound Antiseptics þ Bite Wounds þ Wound Closure þ Wound Infections þ Irrigation Notes on irrigants and wound toxicity: þ Gunshot Wounds - if in soft tissue only, prophylactic antibiotics did not seem to help in an uncontrolled retrospective trial. [Ordog GJ, et al. Infection in minor gunshot wounds. J Trauma 1993;34(3):358.] þ Tetanus Immunization Practicies þ Puncture wounds of foot: