SOFT-TISSUE INJURIES - Medicine for Mountaineering and Other Wilderness Activities - page 164

pinhole can be used as an improvised syringe.) Such rinsing produces little pain and does
not damage the tissues. Obviously, only disinfected water is suitable for such cleansing.
Foreign material, dead tissue, or even clotted blood left in the wound virtually insure in-
fection. Wound cleansing must be complete. The syringe must be repeatedly refilled and
emptiedintothewound.Sterileforcepsshouldbeusedtoremoveanyembeddeddebristhat
cannot be rinsed away; small tags of dead tissue may be snipped off with sterile scissors.
For puncture wounds, bleeding should be encouraged to help remove bacteria and
debris.Thedepthsofsuchwoundsarenotreachedbyair,andanaerobicbacteriathatthrive
in such conditions, such as those that cause tetanus and gas gangrene, can produce devast-
ating infections.
Antiseptics
Antisepticshavelittlevalueinthecontrolofwoundinfections.Theycannotcompensate
for negligent wound cleansing and, for wounds that are thoroughly cleaned, provide little
additional bacterial control. The informed use of the proper antiseptics, however, may help
significantly for animal bites or other heavily contaminated wounds.
Antiseptics placed in a wound must be able to kill bacteria without injuring the tissues.
Minimizingtissuedamageisessentialbecausenoagentcankillallthebacteria,andinjured
tissue provides an excellent medium for the growth of the remaining organisms. The best
readily available antiseptic that meets these qualification is a 10 percent solution of a
povidone-iodinepreparation(Betadine®andothers).Povidone-iodinehastwoadvantages:
Itisidealforscrubbinghandsortheskinaroundawound(whichiswhyitisroutinelyused
by surgeons), and it can be packaged in polyethylene bottles.
Povidone-iodine can be used undiluted for cleansing skin prior to needle punctures, but
for rinsing a wound it should be diluted 10:1 or 20:1 with disinfected water. The wound
should be flooded with the solution.
Antiseptics suchasalcohol,tincture ofiodine,orthemercurial preparations damagetis-
sues and should not be placed directly in an open wound.
Wound Closing
In the wilderness, soft-tissue wounds never need to be sutured. If a wound is left open,
purulent material from infected areas drains to the outside. This purulent material cannot
escape from a sutured wound and is extruded into the surrounding tissues, spreading the
infection. In hospitals, softtissue wounds are sutured under sterile conditions to promote
healing and minimize scarring. However, such sterile conditions rarely can be duplicated
in the wilderness, and the damage done by an infection in a sutured wound would greatly
prolonghealingandleadtofargreaterscarringanddeformity.Furthermore,ifanunsutured
wound is not infected, the edges tend to fall together, healing is rapid, and scarring is min-
imal.