Avoidance of Complications (Haematoma, Pain, and Infection)

The spectre of wound disruption caused by haematoma, complicated frequently by pain and infection, has probably contributed to the unfortunate tendency to bandage wounds firmly. The effects of this on the local circulation, as swelling increases, are rarely if ever acknowledged. A much safer alternative is afforded by achieving haemostasis as an integral part of treatment, so that haemostatic bandaging is never needed. Non-watertight closure of wounds assisted by gravity drainage reduces the risk of haematoma. In closed wounds or spaces such as degloved areas, vacuum drainage can be used for 24 h to prevent accumulations of fluid. The control of bleeding is best achieved by elevation and focal pressure, not by the application of a tourniquet. Complete haemostasis, achieved progressively during treatment, is a specific goal because it means that final dressing tension no longer has to be haemostatic and maximum perfusion of tissue is achieved during the period of reactive swelling. Pain is a protective sensation. Responding to its underlying causes is much more appropriate than simply giving pain relief.