Travel Reference
In-Depth Information
If nonadherent material is not available, an improvised dressing for such wounds can
be made by cutting a piece of a plastic bag a bit larger than the surface of the wound. The
unprintedsideoftheplasticshouldbeplaceddirectlyonthewoundandabandageapplied.
The dressing should be removed every twelve to twenty-four hours and the wound cleaned
as needed. The wound should be dressed in this way until the wound surface is dry. The
surgeon who developed this technique points out that plastic remains more or less sterile,
even when carried in a rucksack, because the material is not a fabric but a solid without
pores.
Skin Flaps and Avulsions
Forces roughly parallel to the skin surface tend to lift or tear out chunks of tissue. If the
tissue is completely torn away, the injury is considered an avulsion. (A limb may be com-
pletelyseveredoravulsed,andfewpeoplesurviveaccidentsinwhichsuchpowerfulforces
are generated.) If the skin along one side remains intact, a skin flap is created. Small skin
flaps are rather common, but occasionally larger flaps are produced.
If the full thickness of the skin is avulsed, the injury should be bandaged like an abra-
sion. As a general rule, wounds of this type that are more than one inch in diameter require
skin grafting, so the person eventually must be hospitalized. Large avulsions are incapacit-
ating.
If a thick flap of tissue with fat or muscle attached to the undersurface has been pro-
duced, the person must be evacuated. Such injuries heal poorly and tend to become infec-
ted. The wound should be thoroughly cleaned and the tissue flap replaced in its original
position. If the tissue flap is large, a strip of gauze should be placed along the lip of the
woundsothat theedgesdonotseal andpurulent exudate canescape ifthewoundbecomes
infected.Thewoundshouldbebandagedwithabulkycompressiondressing,andtheentire
limb shouldbeimmobilized. Theflap,whichmustnotbeallowed tomoveorshiftitsposi-
tion,isinessenceaskingraft.Ifthewoundistoheal,theflapmustremainstationarywhile
new blood vessels grow into it.
The individual must be closely watched for signs of infection, and any wound infection
that does occur must be promptly drained. Antibiotic therapy should be started at the time
of the injury.
In expedition situations, evacuation may not be necessary if the wound appears to be
healing satisfactorily without infection. The tissue flap is less likely to be moved inadvert-
ently while the individual is lying in a tent than when walking or being carried over rough
terrain. However, such wounds do not usually heal without infection, and evacuation may
be much more difficult for a person with a severe injury that is infected.
When the flap does not survive, it first acquires a dusky appearance and then becomes
progressively darker until it is totally black. Uninfected flaps are dry and hard; infected
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