Approach to managing traumatic wounds

The following advice applies to patients with extremity wounds; for patients with other wounds (eg penetrating abdominal wounds, chest trauma), seek expert advice.

For patients with traumatic wounds, ensure that tetanus immunisation is up-to-date (see Requirement for tetanus prophylaxis).

Careful cleaning and debridement of traumatic wounds is important to prevent infection; immobilisation and elevation are also beneficial.

Consider necrotising skin and soft tissue infection in patients with sepsis or septic shock associated with a traumatic wound].

Antibiotics are not routinely required for traumatic wounds. They are used as:

• prophylaxis for wounds requiring surgical management or that are significantly contaminated (eg penetrating injuries through footwear, stab wounds)
• presumptive therapy for bites and clenched-fist injuries at high risk of infection
• prophylaxis for open fractures
• treatment of established infection (see localised infection, infection associated with systemic features or deeper tissues or sepsis or septic shock associated with a traumatic wound).

If antibiotic therapy is indicated for a traumatic wound that has been immersed in water, see Water-immersed wound infections for antibiotic choice.

Collect samples for Gram stain and culture before antibiotic therapy is started.

Likely pathogens in post-traumatic wound infection include Staphylococcus aureus and Streptococcus pyogenes (group A streptococcus). Anaerobic post-traumatic wound infection (eg Clostridium perfringens infection) is rare but may follow severe injuries if the wound is heavily contaminated. A broader range of pathogens are seen in infections of traumatic wounds that have been immersed in water, including soil- or sewage-contaminated water (eg injuries sustained in a natural disaster, marine injuries).