Wound Protocol: Surgical & Non-surgical Wounds with Plaster

Protocol Developed by:
Orthopaedics: Prof. Phong Tran, Dr. Bill Zhang, Dr. Toan Phu
Geriatrician: Dr. Mark Johannesen
Plaster Technicians: John, Jade, Mark, Kris, Sarah, Jacob, Anna
Williamstown Lower West Nurse Unit Manager: Abigail Davis

Who Should I contact?

  1. Ortho Registrar On Call – via Switchboard
  2. Plaster Techs: 0407548623

Wound and Dressing Management e-Module:
https://welearn.wh.org.au/course/view.php?id=960

Surgical Wounds

  • Type of surgical incision/ wound. 
  • suture material, dressing & orthosis (e.g. backslab, full cast, camboot, sling)
  • Wound review timing
    • If outpatient: Ortho Postop Clinic, Post Acute Care (PAC) at home, GP 
    • If inpatient: home team (e.g. Ortho, GEM, Rehab)
      • call Ortho Reg if any concerns
  • Any changes to plan post wound review. E.g:

Common suture material:

Suture TypeSuture Name – ColourComments
AbsorbableMonocryl – clear (commonly written on op report as 3-0M)Vicryl – white or purple (commonly written on op report as 1V or 2-0V)Monocryl tails are often left sticking out the skin. Once wound is healed (typically 2 weeks), excess monocryl can be trimmed flush to skin
Non-absorbableNylon – black
Prolene – blueStaples – silver		Typically non-absorbable sutures are removed 2-3 weeks. Ensure there is no retained material (only cutting 1 end of the suture helps)

Non-surgical Wounds

Examples:

  • Skin tears from injury or from reduction
  • Fracture blisters
  • Bruising, haematoma, tented skin from fracture/ dislocation
  • Open fractures (typically Gustillo Anderson Grade 1 open punctures)
  • Grazes, abrasions

Pathway

  1. Primary referrer (ED, GP, home team) to take a photo of the wound, upload to EMR & discuss with On Call Ortho Reg
  2. Ortho Reg to decide plan re:
    • Wound: debridement, dressing, antibiotic requirement, ensure ADT up to date
    • Fracture: cast type, WB status
      • Always consider a window in the cast unless clear reason i.e. fracture reduction, cast integrity
    • Followup: review time
  3. Review
    • Inpatient: Discuss with Ortho Reg to update plan & then home team to coordinate with Plaster Techs
    • Outpatient: Refer to Ortho Fracture Clinic

Plaster options:

  • Full cast
    • Pros: more rigidity, hold reduction. Can WB in some casts (e.g. TCC, gutter frame WB with distal radius # in full cast)
  • Alternative options:
    • Full cast
      • Window cut out
      • Clam shell brace (full cast split & held together by velcro straps, easily removed for skin checks)
    • Half cast/ backslab/ volarslab
    • Removable splints (e.g. wrist splint, zimmer knee splint, camboot, hinged knee brace)