I. Gunshot wound

While at home:

• Keep the wound clean and dry. If a bandage was applied and it becomes wet or dirty, replace it. Otherwise, leave it in place for the first 24 hours.
• Clean the wound daily:

After removing the bandage, wash the area with soap and water.

You may shower as usual after the first 24 hours, but do not soak the area in water (no tub baths or swimming) until after you follow up with your doctor.

• If bleeding occurs from the wound, cover with a gauze or towel and apply firm direct pressure without letting go for 5 full minutes by the clock. This gives time for a clot to form. If this does not stop bleeding, return to the hospital promptly.

Follow Up:

Most skin wounds heal within ten days. However, even with proper treatment, a wound infection may occur. Check the wound daily for signs of infection listed below. 

Return for a wound check when instructed.

Call your doctor right away if you notice:

• Increased drainage or bleeding from the wound that won’t stop with direct pressure
• Redness in or around the wound
• Foul odor or pus coming from the wound
• Increased swelling around the wound
• Fever above 101.0°F or shaking chills

A note about retained bullets:

Bullets do their damage at the time of injury.  Once a bullet or fragment comes to rest, it rarely causes any further problem.  Unlike what you may have seen on television, it is usually not necessary to remove the bullet.  In fact, removing a bullet or its fragments may cause more damage to the surrounding tissues.

II. Stab Wound

A stab wound usually causes a small opening at the skin, but may go very deep. As a result, nerves, tendons, blood vessels and organs can be injured. Your exam today did not show injury to any deep organs or tissues. Sometimes a deep injury may not be found during the first exam, so watch for the signs below.

Because this is a type of puncture wound, the skin opening is not sutured closed. This is to reduce problems in the event of an infection. As a result, blood may ooze from the wound opening during the first 24 hours. 

While at home:

• Keep the wound clean and dry. If a bandage was applied and it becomes wet or dirty, replace it. Otherwise, leave it in place for the first 24 hours.
• Clean the wound daily:

After removing the bandage, wash the area with soap and water. Use a wet cotton swab (Q tip) to loosen and remove any blood or crust that forms.

You may remove the bandage and shower as usual after the first 24 hours, but do not soak the area in water (no swimming or tub baths) until after you follow up with your doctor.

• If bleeding occurs from the wound, cover with a gauze or towel and apply firm direct pressure without letting go for 5 full minutes by the clock. This gives time for a clot to form. If this does not stop bleeding, return to the hospital promptly

Follow Up:

Most skin wounds heal within ten days. However, even with proper treatment, a wound infection may occur. Check the wound daily for signs of infection listed below.

Return for a wound check when instructed.

Call your doctor right away if you notice:

• Increased drainage or bleeding from the wound that won’t stop with direct pressure
• Redness in or around the wound
• Foul odor or pus coming from the wound
• Increased swelling around the wound
• Fever above 101.0°F or shaking chills

III. Sutures, Staples, Steri-Strips

While at home:

• Keep the wound clean and dry.
• If you were given a bandage, you may change it daily as follows:
  • After removing the bandage, wash the area with soap and water.
  • After cleaning, reapply a fresh bandage.
  • You may remove the bandage to shower as usual after the first 24 hours, but do not soak the area in water (no tub baths or swimming) until the sutures are removed. 

Follow Up:

If sutures or staples are in place, it is important to keep your appointment for removal. If they are left in place too long permanent marks may remain.

If Steri-Strips were applied, they will usually fall off by themselves after 10-12 days. 

Call your doctor right away if you notice:

• Increased drainage or bleeding from the wound
• Redness in or around the wound
• Foul odor or pus coming from the wound
• Fever above 101.0°F or shaking chills

IV. Wound packing

Your doctor wants you to apply a special dressing, or packing, to your wound. When a wound is deep, or when it tunnels under the skin, packing the wound can help it heal. The packing material absorbs any drainage from the wound, which helps the tissues heal from the inside out. Without the packing, the wound might close at the top, without healing at the deeper areas of the wound. You were shown how to pack your wound before you left the hospital. The following guidelines will help you remember how to take care of your wound.

Your supplies: 

Keep your supplies all in one place. Put them in a basket or large bag. You will need the following:

• Packing material
• Sterile wetting solution
• Sterile gloves
• A clean bowl
• Scissors
• A clean towel
• Outer dressing material (a bandage to put on the top of the wound after you have packed it)
• Tape
• Cotton swabs or Q-tips
• A small plastic bag

Procedure:

• Clean the area where you will set out your dressing supplies.
• Wash your hands thoroughly with soap and water.
• Put a clean towel over the area and set a clean bowl on it. Don’t touch the inside of the bowl.
• Pour enough wetting solution into the clean bowl to wet the packing material.
• Cut off a length of packing material and drop it carefully into the bowl of wetting solution. (You will need less packing material as your wound heals)
• Cut pieces of tape to desired lengths. You will use these strips to secure your outer dressing. For now, hang the pieces of tape on the edge of your work surface.
• Gently remove your existing bandage (old tape, outer dressing, and packing). Put these items in a small plastic bag for disposal.
• Wash your hands thoroughly again. Use soap and water.
• Put on the gloves. Gently squeeze the packing material to get rid of excess wetting solution. The packing material should be wet, but not dripping.
• Gently put the packing material into the wound. Packing should fill the wound space completely, but not tightly. Use a cotton swab or Q-tip to gently guide the packing into small or tunneled areas.
• Open your outer dressing material and place it on the towel. Keep it away from the bowl, and don’t get it wet.
• Put the outer dressing over the packing and wound site.
• Tape the outer dressing in place.
• Remove your gloves.
• Wash your hands one more time with soap and water.

Be sure to follow-up when instructed. 

Call your doctor right away if you notice: 

• Increased drainage from the wound
• Redness in or around the wound
• Wound tissue that changes from pink to white, yellow, or black in color
• Odor coming from the wound
• Increased size or depth of the wound
• Fever above 101.0°F or shaking chills

Kimberly Nagy, MD August 2013