Wound dressings - acute traumatic wounds

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    Key Points

    1. All wound care including cleaning, irrigation and dressings should be managed with an aseptic technique
    2. Initial decontamination of the wound with irrigation is of utmost importance and should be performed prior to dressing
    3. Most wounds do not require antibiotic therapy if cleansed and decontaminated adequately
    4. Provide adequate analgesia during wound care


    Objectives of wound care are to:

    • reduce pain 
    • promote wound healing
    • reduce infection risk
    • optimise cosmetic and functional outcome

    Actions to achieve this include:

    • wound cleaning
    • closure (if appropriate)
    • dressing
    • antibiotic prophylaxis (if appropriate)
    • immobilisation
    • compression (to achieve haemostasis)



    • Mechanism of injury, associated blood loss, risk of contamination, deeper structure damage
    • Tetanus status
    • Red flags for child abuse
    • Underlying chronic illness or disability


    Fully examine the injured part, in particular checking for: 

    • underlying nerve, vessel and tendon damage. This requires assessment of movement while exploring the wound (especially in palmar or hand wounds: see "fight bite")
    • tissue damage or loss

    Assessment of severity

    • Location of wound
    • Appearance/presentation. See additional notes for wound bed characteristics
    • Exudate type and amount
    • Wound dimensions
    • Colour
    • Condition of surrounding skin
    • Presence of odour


    • Consider X-ray for underlying fracture or radiopaque foreign body eg glass or metal  
    • Consider ultrasound for puncture wounds with a radiolucent foreign body eg thorn or splinter
    • Consider swab for MCS only if considering antibiotics


    Wound cleansing/irrigation is important for decreasing bacterial load. Cleansing/irrigating with antiseptics may damage tissue defences and impede healing. The exception is contaminated wounds that may benefit from chlorhexidine 0.05% or povidine-iodine 1% irrigation

    • Provide adequate pain management, anaesthesia (see anaesthesia in lacerations) and procedural sedation
    • Irrigation fluid delivery:   
      • Use a 20-30 mL syringe with a large bore non bevelled needle filled with 0.9% sodium chloride to slowly irrigate the wound
      • Consider use of a splash guard
      • Hold the syringe just above the top edge of the wound using continuous gentle pressure to flush fluid
      • Thorough irrigation (eg 50-100mL per cm length of wound) is required
    • Consider referral for plastic or general surgical opinion either in ED or as outpatient for:
      • cosmetically sensitive wounds
      • deep wounds or wounds with significant tissue loss
      • involvement of underlying structures such as tendons, nerves and vessels


    • Most wounds do not require antibiotic therapy
    • Initial decontamination of wound is more important. See Cellulitis and skin infections
    • Antibiotics should be reserved for:
      • animal/human bites
      • penetrating wounds of vital structures (eg eye)
      • contaminated wounds especially when deep
      • severe or contaminated water-wounds
      • when wound cleaning has been delayed (> 8 hours)
      • wounds with extensive tissue damage or massive contamination

    General Principles of Dressing Selection

    • Hydrogels for debridement stage
    • Low adherent moisture maintaining for granulation stage
    • Low adherent for epithelialisation stage

    Type of wounds and dressing options
    See burns for burns dressing advice

    Wound Type

    Dressing Role


    Review Time

    Graze, abrasions - clean

    Keep dry

    Film, tulle, fixation sheet or dry

    2 days

    Graze, abrasions - soiled

    Keep dry

    Dry or tulle

    2 days

    Lacerations - sutured/ glued/ closed

    Protect and minimise irritation

    Open or dry, consider paper tape support following suture removal

    3-7 days

    Puncture wounds

    Keep dry, allow visualisation of wound

    Open or dry

    1-2 days

    Slough – dry

    Hydration. Control moisture balance.
    Promote debridement

    Moisture retention eg hydrocolloid, semi permeable


    Slough – moist

    Fluid absorption. Protect surrounding skin.
    Promote debridement

    Absorbent dressing eg alginate, foam


    Necrotic – dry

    Hydration. Promote debridement

    Moisture retention eg hydrocolloid, semi permeable

    3-4 days

    Infected wound

    Antimicrobial. Moist healing.
    Odour absorption

    Avoid semi occlusive dressings. Consider alginate or hydrocolloid if high exudate

    1-2 days

    Chronic wounds eg ulcers, PEG site

    Moisture retention/fluid absorption

    Hydrocolloid, alginate, foam

    5 days

    Dressing Choices

    Dressing types






    Thin, adhesive, transparent polyurethrane film

    OpSite, Tegaderm

    Allows inspection. Self-adhesive. Some moisture evaporation. Reduces pain. Barrier to external contamination

    Exudate may pool. May be traumatic to remove. Surrounding skin may become macerated

    Superficial wounds. As a secondary dressing

    Highly exudative wounds

    Non adherent Moist (Tulle Gras Dressing)
    Gauze impregnated with paraffin or similar. May be impregnated with antiseptics or antibiotics

    Jelonet, Unitulle Bactigras, Sofra-Tulle

    Reduces adhesion to wound. Moist environment aids healing. Easy to use. Low cost

    Do not absorb exudate or maintain moisture. Requires secondary dressing. May induce allergy or delay healing when impregnated

    Burns. Wounds healing by secondary intention


    Non adherent Dry
    Thin perforated plastic film coating attached to absorbent pad

    Melolin, Melolite, Tricose

    Low wound adherence. May absorb light exudate

    Not suitable in high exudate. Can dry out and stick to wound. Requires secondary dressing

    Wounds with moderate exudate

    Dry wounds (may cause tissue dehydration)

    Fixation Sheet
    Porous polyester fabric with adhesive backing

    Fixomull, Hypafix, Mefix

    Can be used directly on wound site. Conforms to body contours, good pain relief and controls oedema. Remains permeable allowing exudate to escape and be washed and dried off wound. Dressing changes can be left for 5-7 days

    Dressing needs washing with soap and water, pat-dried twice daily. Requires application of oil prior to removal, ideally soaked in oil and wrapped in cling film overnight

    Wounds with mild exudate, not needing frequent review

    Infected wounds. Allergy to adhesives

    Calcium Alginate
    Natural polysaccharide from seaweed


    Forms gel on wound and hence moist environment. Reduces pain. Can pack cavities. Absorbent in exudative wounds. Promotes haemostasis. Low allergenic

    May require secondary dressing. Not recommended in anaerobic infections. Gel can be confused with slough or pus in wound. Must be removed to monitor wound. Unpleasant odour

    Moderately or highly exudative wounds. Need for haemostasis

    Dry wounds or hard eschar

    Foam Dressings Polyurethane foam dressing with adhesive layer incorporated


    Moist, highly absorbent, protective. Can be used to pack cavities

    Set size of foam may be limited by wound size. Needs daily change

    Wounds with mild to moderate exudate

    Dry wounds. Wounds that need frequent review

    Hydrocolloid Dressings Polyurethane film coated with adhesive mass

    Duoderm, Comfeel

    Retains moisture. Painless removal

    Malodour. Potential allergic contact dermatitis

    Burns (small). Abrasions

    Dry wounds. Infection


    Intrasite Gel

    Can provide or absorb moisture depending on surrounding tissue. Initially lower temperature providing cooling

    May need a secondary adhesive dressing

    Dry wounds

    Suspected gram-negative infections

    Paper adhesive tapes
    Adhesive tape may be applied directly to healing laceration


    Non allergenic. Provides wound support

    Non absorbent

    Small wounds

    Exudative or large wounds


    Acticoat, Aquacel Ag, Idosorb

    Decrease bacterial load


    Infected wounds. Burns

    Caution use of iodine dressings in patients with thyroid disease

    Post Dressing Care and Discharge instructions

    Provide education regarding wound healing, monitoring for signs of infection and scar minimisation strategies, including:

    • Avoid sun exposure
    • Scar massage from 2-4 weeks following wound closure/suture removal 5-10 min twice daily
    • Moisturising creams such as vitamin E, aloe vera and sorbelene can be used to soften scar and make massage easier

    Consider consultation with local paediatric team when

    Consider consultation with surgical/plastics team when

    • Wound dressing too complex to complete or specific dressings not available

    For emergency advice and paediatric or neonatal ICU transfers, see Retrieval Services

    Consider discharge when

    • Dressing applied and follow-up plan in place

    Parent information

    Wound care

    Additional notes

    Wound Bed Type



    Pinkish/red coloured moist tissue. Bleeds easily


    Pink, almost white. Only occurs on top of healthy granulation tissue


    Devitalised yellowish tissue. Accumulation of dead cells, not pus


    May appear hard, dry and black or grey. Presence of dead tissue prevents healing


    Granulation tissue growing above wound margin

    Images sourced from SCHN wound assessment and management guideline. Available from: https://www.schn.health.nsw.gov.au/_policies/pdf/2014-9040.pdf

    Last updated March 2023

  • Reference List

    1. Armstrong, D et al. Basic Principles of Wound Management. Up To Date.2020. [updated 12/07/2020] (viewed 10 May 2022).
    2. Jaman, J et al. Is the use of specific time cut-off or “golden period” for primary closure of acute traumatic wounds evidence based? A systematic review. Croatian Medical Journal. 2021. 62 pages 614-622.
    3. Jones, V et al. Wound dressings. British Medical Journal (Clinical research ed). 2006. 332(7544), p777–780. https://doi.org/10.1136/bmj.332.7544.777.
    4. Lammers, RL et al. Prediction of traumatic wound infection with a neural network-dervied decision model. American Journal of Emergency Medicine. 2003. 21(1), pages 1-7.
    5. Morgan, WJ et al. The delayed treatment of wounds of the hand and forearm under antibiotic cover. British Journal of Surgery. 1980. 67(2), pages 140-141.
    6. Perth Children’s Hospital. Wound care. https://pch.health.wa.gov.au/For-health-professionals/Emergency-Department-Guidelines/Wound-care (viewed 10 May 2022).
    7. Shepherd, M & Starship hospital et al. Lacerations and Wound Closure. https://starship.org.nz/guidelines/lacerations-and-wound-closure/ (viewed 10 May 2022).
    8. The Sydney Children’s Hospitals Network. Wound assessment and management: Practice Guideline. https://www.schn.health.nsw.gov.au/_policies/pdf/2014-9040.pdf (viewed 10 May 2022).
    9. Waseem, M et al. Is there a relationship between wound infections and laceration closure times? International Journal of Emergency Medicine. 2012. 5:32.
    10. Wolcott, RD et al. Role of wound cleansing in the management of wounds. Wounds Middle East. 2014. 1(1) p33-38.