Dermabond not letting wounds weep a bad thing?

[zombie360]

I was thinking about getting some dermabond but after thinking about it I understand the protective skin dermabond makes over an injury keeps germs out, but I'm worried it might cause problems by not letting the wound weep and trapping germs.
Any thoughts?

[TacAir]

Depends on how deep the wound is in fact.

[boskone]

Depends on the nature of the wound. But you should clean the wound before applying something like dermabond anyway.

Or even bandages or something like vaseline, for that matter.

[zXzGrifterzXz]

Liquid skin on a paper cut that has been well cleaned prior to sealing, probably ok.

But yes, sealing a legit(read as: Non superficial) wound without throughout cleaning or prophylactic antibiotics can be a recipe for sepsis and disaster.

Unpopular opinion: Wound vac/drains are for Docs that are too lazy to do daily dressing changes. Just kidding, they have their place but can be overused by busy services.

As always, just my opinion.

[CrossCut]

Not like I'm qualified to have an opinion, but here it is anyway.

Chapter 54, Wounds, of the free Primary Surgery Vol 2 book taught me a lot. https://www.ghdonline.org/surgery/discu ... olume-2-2/ A laceration on the cheek you kiss should be handled differently than a laceration on the cheek you sit on, summarizing. Secondary or delayed primary closure requires more wound care and supplies, but seems generally safer. Except for very recent wounds on the face, head, or hands, primary closure (using sutures, staples, or glue) probably isn't a good idea.

There is seldom any indication for suturing any wound in the interval between 6 hours and the third day, with the possible exception of clean knife wounds.

and

Many tragedies, including osteomyelitis and death, result from treatment which is perfect in every way, except that the wound was sutured immediately, when delayed closure would have been wiser. The temptation is great because a wound looks so much tidier when it is neatly sewn up! Unfortunately, dirt, dead tissue and bacteria may all be hidden under a beautifully sutured wound.

Something else to consider, purely speculation on my part, but maybe especially true in the PAW when antibiotics and/or tetanus vaccine/antitoxin aren't available, is antiseptics for wound irrigation and cleansing. I think diluted 10% povidone iodine makes sense given its broad antimicrobial activity, including activity against the spores that cause gas gangrene and tetanus. Not many antiseptics are sporicidal. Even though there's studies that show delayed wound healing and scarring with it over saline or clean water, those seem trivial if you can reduce the risk of deadly infection.

[dallas]

I was thinking about getting some dermabond but after thinking about it I understand the protective skin dermabond makes over an injury keeps germs out, but I'm worried it might cause problems by not letting the wound weep and trapping germs.
Any thoughts?

A wound does not need to drain unless it is contaminated. They wound should be cleaned well before using dermabond.

[dallas]

Not like I'm qualified to have an opinion, but here it is anyway.

Chapter 54, Wounds, of the free Primary Surgery Vol 2 book taught me a lot. https://www.ghdonline.org/surgery/discu ... olume-2-2/ A laceration on the cheek you kiss should be handled differently than a laceration on the cheek you sit on, summarizing. Secondary or delayed primary closure requires more wound care and supplies, but seems generally safer. Except for very recent wounds on the face, head, or hands, primary closure (using sutures, staples, or glue) probably isn't a good idea.

There is seldom any indication for suturing any wound in the interval between 6 hours and the third day, with the possible exception of clean knife wounds.

and

Many tragedies, including osteomyelitis and death, result from treatment which is perfect in every way, except that the wound was sutured immediately, when delayed closure would have been wiser. The temptation is great because a wound looks so much tidier when it is neatly sewn up! Unfortunately, dirt, dead tissue and bacteria may all be hidden under a beautifully sutured wound.

Something else to consider, purely speculation on my part, but maybe especially true in the PAW when antibiotics and/or tetanus vaccine/antitoxin aren't available, is antiseptics for wound irrigation and cleansing. I think diluted 10% povidone iodine makes sense given its broad antimicrobial activity, including activity against the spores that cause gas gangrene and tetanus. Not many antiseptics are sporicidal. Even though there's studies that show delayed wound healing and scarring with it over saline or clean water, those seem trivial if you can reduce the risk of deadly infection.

On my medical missions in under developed areas, it is always delayed closure. I carried for one guy that was hit with a machete across the face in the middle of his nose. The cut went through his nose and into both cheeks. Someone did an immediate primary closure on him, and he got a raging infection. I managed to save him with a lot of IV antibiotics. I have also managed a couple of hand amputations from machetes along with the routine knife cuts.

I like occlusive dressings.

[JeeperCreeper]

Unpopular opinion: Wound vac/drains are for Docs that are too lazy to do daily dressing changes. Just kidding, they have their place but can be overused by busy services.

As always, just my opinion.

I generally disagree. I can see how they can be over used, but in the acute setting, they are very necessary.

Maybe I'm just lucky that my hospital has a wound care team that's on top of things, but they aren't MDs, they're RNs.

Wound vacs generally promote healing in hyper complex cases, in my experience... Kinda necessary on things like residual limbs, necrotizing fasciitis, diabetic and pressure wounds.

I'd be curious as to what setting you got your views on them? SNF?

[zXzGrifterzXz]

I'd be curious as to what setting you got your views on them? SNF?

During clinical rotations in Burn care. But honestly I’m just kidding, Wound vacs definitely have their place in recovery. Happily I’m a caveman paramedic so I don’t have to worry about placing them.

[JeeperCreeper]

I'd be curious as to what setting you got your views on them? SNF?

During clinical rotations in Burn care. But honestly I’m just kidding, Wound vacs definitely have their place in recovery. Happily I’m a caveman paramedic so I don’t have to worry about placing them.

Ahhhh I can see that in burn care at a "factory facility". I honestly don't see many burns, and we never used wound vacs for the few that we get. I could be wrong, but I also don't know what the standard of care is for them. We normally ship them out to a specialty hospital for serious burns