Evidence-Based Care of Acute Wounds: A Perspective

Abstract

Significance: Large variation and many controversies exist regarding the treatment of, and care for, acute wounds, especially regarding wound cleansing, pain relief, dressing choice, patient instructions, and organizational aspects. Recent Advances: A multidisciplinary team developed evidence-based guidelines for the Netherlands using the AGREE-II and GRADE instruments. A working group, consisting of 17 representatives from all professional societies involved in wound care, tackled five controversial issues in acute-wound care, as provided by any caregiver throughout the whole chain of care. Critical Issues: The guidelines contain 38 recommendations, based on best available evidence, additional expert considerations, and patient experiences. In summary, primarily closed wounds need no cleansing; acute open wounds are best cleansed with lukewarm (drinkable) water; apply the WHO pain ladder to choose analgesics against continuous wound pain; use lidocaine or prilocaine infiltration anesthesia for wound manipulations or closure; primarily closed wounds may not require coverage with a dressing; use simple dressings for open wounds; and give your patient clear instructions about how to handle the wound. Future Directions: These evidence-based guidelines on acute wound care may help achieve a more uniform policy to treat acute wounds in all settings and an improved effectiveness and quality of wound care.

Dirk T. Ubbink, MD, PhD

Figure 1.

Critical directions from the guidelines, as summarized in the Dutch “Choosing wisely” campaign. To see this illustration in color, the reader is referred to the web version of this article at www.liebertpub.com/wound

Figure 1.

Critical directions from the guidelines, as summarized in the Dutch “Choosing wisely” campaign. To see this illustration in color, the reader is referred to the web version of this article at www.liebertpub.com/wound

Figure 2.

Flow chart showing the various options for analgesic treatment of wound pain. To see this illustration in color, the reader is referred to the web version of this article at www.liebertpub.com/wound

Figure 3.

Flow chart showing the various cleansing, dressing, and topical agent options for acute-wound care. To see this illustration in color, the reader is referred to the web version of this article at www.liebertpub.com/wound