!Wounds

Wound care steps:
-----------------
 * Stop the bleeding with pressure.
 * Clean the wound thoroughly as soon as you can. The better you clean it, the 
   less likely it is to become infected. For larger wounds, give some kind of 
   pain medicine before you clean and care for the wound. Inject lidocaine 
   around the wound and just below the skin inside it. Or give another pain 
   medicine and allow time for it to work.
 * Dress or close the wound, or for a small wound, leave it open to heal.

Clean all wounds
----------------
Any wound, big or small, can become infected. Clean every wound well.

Wash your hands well with soap. Then wash the wound with 1 to 4 liters of 
flowing water. You do not need antiseptics, some of which can slow healing 
down. If the wound looks dirty, use soapy water and then rinse that off with 
plain water.

Lift up any flaps of skin to clean underneath. For deep wounds, squirt the 
inside of the wound with a bulb syringe, letting the water run out.

Or take the needle off a syringe and squirt water into the wound.

Or just run lots of clean water over and into the wound.

Wash out anything left inside the wound, especially dirt, wood, or other rough 
material. You may need to use a piece of sterile gauze or clean fabric to 
clean out the wound, then rinse thoroughly.

Caring for wounds
-----------------
As the wound heals, make sure it stays clean to prevent infection. If it gets 
dirty, clean the wound with lots of water. Covering the wound with a bandage, 
sterile gauze, washed banana leaf, or very clean piece of cloth will help keep 
it clean. Putting honey on the wound also helps prevent infection. Change the 
bandage daily, and if it becomes wet or dirty. It is better to have no bandage 
than one that is dirty or wet.

Watch for signs of infection such as increasing redness, pain, heat, swelling, 
bad smell or pus at the site of the wound. For any of these signs, clean the 
wound well.

You may need to gently pull open the wound to clean it. Watch that the 
infection does not spread to other parts of the body.

Closing wounds
--------------
A small wound is best left alone to heal. It should not need stitches. The 
most important thing is to keep wounds clean.

A wound that is more than 12 hours old should be cleaned and left open to 
heal.

A larger wound that comes together well will heal better if it is closed.

To close a shallow, clean wound, use butterfly bandages, glue, or stitches.

    Butterfly bandage
    -----------------
    Use a butterfly bandage for a small cut. The skin around the wound must be 
    clean and dry for the bandage to stick.

    Glue
    ----
    Super Glue or Krazy Glue (cyanoacrylate, a powerful adhesive) is easier to 
    use than suture and works just as well for most wounds. Use it when you 
    can clearly see how the two sides of the wound should go together. It may 
    not work as well on hands or joints because they move so much. Do not use 
    glue near the eyes or mouth. Super Glue may irritate the skin. 

     1. Make sure the wound is clean and the skin around it is dry.
     2. Push the sides of the wound together. Keep fingers well away from the 
        wound so they do not stick to the glue. A helper can use a couple of 
        clean sticks to hold the sides together.
     3. Squeeze a line of glue along the closed edges of the wound.
     4. Hold the wound closed for 30 seconds. Then add another layer of glue. 
        Wait another 30 seconds or so, and then add a third layer. Each layer 
        should cover a little more of the surrounding skin than the last.

    The glue will wear away on its own. By then the wound should be healed.

    Stitches (sutures)
    ------------------
    A cut will benefit from stitches if it is shallow and long, or if the 
    edges of the skin around the cut do not come together by themselves.

    Line up the edges. The edges of the wound should come up slightly above 
    the skin instead of tucking into the wound.

    Make the depth and the length of the stitch the same on each side of the 
    wound.

    If you do not have suture or a curved suturing needle, sharpen a sewing 
    needle. Boil the needle, some silk or nylon thread, and a small pair of 
    pliers for pulling the needle through tough skin.

     1. Put the stitch through the cut, not under the cut.
     2. Tie a secure knot.
     3. Make enough stitches to close the whole cut.

    A deep wound should get a couple of stitches inside the muscle with 
    dissolvable suture before sewing the skin together. If you cannot do this 
    then do not close the wound.

    How to tie a strong knot: 

     1. First tie a simple knot and pull skin together.
     2. Tie a second simple knot over the first one.
     3. Tie a third simple knot over the second one.
     4. Tie a fourth simple knot over the third one.

    Leave stitches in place for about one week (10 days for a leg or joint 
    wound). Then cut each stitch and pull it out. If you spend some time 
    sewing clothes, you will find that your skill to suture wounds improves as 
    well. 

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Hesperian Health Guides 1919 Addison St Ste 304 Berkeley CA 94704
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