Welcome back to Mangled Mondays, where every Monday we talk about another facet of maiming, mangling, mauling, and mistreating your main characters — and all of their friends.
Today we’ll be talking about Wound Care. For the rest of the Mangled Mondays series, [click here].
]Wound care is, in and of itself, an enormous topic. There are entire teams in hospitals dedicated to wound care and helping people heal.. To cover it in one chapter is a hopeless endeavor.
How to Clean a Cut
Cleaning a wound has two goals: getting out obvious pieces of dirt or other contaminants, and killing bacteria that are located in the wound. This is generally accomplished with irrigation (running sterile water or tap water through the wound) and application of an antiseptic. Antiseptics are materials, usually liquids, that are used to kill bacteria.
Antiseptics are actually pretty controversial in medicine, and it’s okay if your characters choose to use them, or choose not to use them. Neither answer is “right,” although if the wound has been exposed to something like mud or a dirty river, your characters will likely choose to use an antiseptic.
The argument in favor of using antiseptics is that they kill bacteria, which theoretically improves wound healing and is safer in the long run. Bacterial infections compete for nutrients with the damaged tissue and cause prolonged inflammation of the wound. This is especially true in characters whose immune systems are compromised or who may not have ideal circulation to the wounded area, such as diabetics or those with HIV.
The argument against antiseptics is that they may, on a cellular level, damage the tissue most in need of healing.
If your characters are going to use antiseptics on their wounds, they’ll likely use povidine-iodine (known in the biz by a popular brand name, Betadine) or hydrogen peroxide to clean their wounds. Alcohols aren’t recommended, becaeuse they tend to damage the cells of the tissue that’s trying to heal.
(It’s worth noting, by the way, that doctors are split over hydrogen peroxide for initial wound cleaning; the doctors who edited this book agreed that Betadine is better for ongoing wound care.)
However, whatever a character has always used is what they will reach for in their time of crisis.
Open or Closed?
When it comes to the decision to close a wound with sutures, time is an important factor.
A wound that remains open for 24 hours after the initial injury is actually better off staying open. It has a better chance of healing well on its own than it will if it’s closed after 24 hours, and many doctors have a hard 12-hour cutoff for wound closure. One guideline is that after 6–8 hours, wounds that aren’t on the face or scalp will be left open.
Missing Flesh or Bite Wound = Open Approach
The deeper the wound, the more likely an open approach will be used. That’s because closing a wound over missing tissue entraps bacteria and makes it likely that infection will develop where it cannot drain.
Bite wounds cannot be sutured for the same reason wounds that have removed chunks of flesh cannot be sutured: bacteria trapping can be fatal. Bites are especially prone to bacterial infection, because mouths are filthy, filthy places filled with bacteria. If your character chooses not to seek medical help for a cat or human bite, it’s particularly likely to get infected; a dog bite is less so.
Surgical Wounds = Drains
Surgical incisions into the chest or the abdomen typically have a plastic tube left in place to drain the wound in order to make sure that no fluid builds up in the cavity. Not only does this help prevent infection, it reduces the time it takes to heal and allows the staff to be certain that a wound is healing well on the inside.
If an incision and the underlying surgical wounds are healing well, the drain can usually be removed in 1–3 days.
xoxo, Aunt Scripty
This post is an excerpt from Blood on the Page Volume One: A Writer’s Compendium of Injuries. The book details thirty-one injuries with which to maim, mangle, and maul your characters, as well as nine indispensable articles of Wound Wisdom covering everything from burn stages to suture selection.
Spend Less Time Researching and More Time Writing. Pick up a Copy of Blood on the Page Volume One.