Critical Appraisal Of The Literature
The literature review was launched with Ovid MEDLINE® and PubMed searches for articles on wound care published between 1966-2005. Keywords included laceration, wound irrigation, oral wound, wound closure, delayed wound closure, and foreign body. The articles thus obtained provided excellent background for further manual literature searches. Over 400 total articles were reviewed, and 225 of these are included here for the reader’s reference. A search of the Cochrane Database of Systematic Reviews produced reviews updated in 2004 on water for wound cleansing, use of tissue adhesives, and glove and mask use in reducing infection. In addition, ACEP provided a 1999 “Clinical policy for the initial approach to patients presenting with penetrating extremity trauma,” while a search of www.guidelines.gov offered no existing guidelines for lacerations or acute traumatic wound care.
The literature on historical factors predisposing to wound infection is predominantly based on surgical incision literature from the 1970s and 1980s, with a few notable recent papers. The literature basis for proper wound cleansing consists primarily of animal studies from the 1970s, with a limited number of recent studies. The use of delayed primary closure for wounds is based almost entirely on literature from the First and Second World Wars, and its subsequent application in the 1950s to the civilian sector.
The most notable areas in the recent literature deal with new techniques (eg, cyanoacrylate skin closure, topical anesthesia, and the questioning of some long-held beliefs, such as the use of sterile gloves for laceration repair) and the necessity of using sterile saline for wound irrigation.