(4) Irrigate wound with sterile saline to remove exudate and debris.
(5) Topical agents may be used if the wound is colonized, infected, or at risk of being infected.
Routine use of antiseptic solutions is not recommended because most solutions destroy granulation tissue.
i. Silver sulfadiazine cream is contraindicated
in infants less than 30 days of age because
the sulphonamides increase the risk of kernicterus. In addition, the cream can obscure
the wound by forming a difficult to remove
opaque layer.
ii. Use of povidone–iodine is not recommended because absorption of iodine may
suppress thyroid function.
iii. Antibacterial creams and ointments have
limited roles.
(6) Wound dressing
i. The selection of dressing material depends
on the depth of the wound, the property of
the wound bed (presence of granulation tissue, moist, dry, exudative) (19).
ii. Wet wounds require absorptive dressing,
whereas dry wounds benefit from hydrating
dressings.
iii. Amorphous hydrogels consisting of carboxymethylcellulose polymer, propylene glycol,
and water have been shown to keep the
wound moist and facilitate wound healing
(13,19). They are available in the form of
gels or sheets, which may be applied directly
to the wound surface and held in place
by a secondary dressing. The gel is easily
removed with saline and is generally
changed every 3 days. More frequent dressing changes may be required if there is excessive exudation.
iv. Silver-impregnated dressings are postulated
to decrease wound infection (20).
v. Alginate dressings are fibers derived from
brown seaweed and useful for wounds with
moderate to heavy exudates (19).
vi. Polyurethane foams are also useful for
wounds with exudates.
(7) If the scar involves a flexion crease, passive rangeof-motion exercises with each diaper change
may help to prevent contractures.
(8) Plastic surgical consultation
a. Recommended for all full-thickness and
significant partial-thickness extravasation
injuries
b. Enzymatic or surgical débridement or skin
grafting may be required (3,21–24).
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