Table 1.

Overview of the recommendations

Wound cleansing and antisepsis

1. The cleansing of primarily closed wounds is dissuaded.

2. Dirty open wounds (street, bite, or cut wound) should be cleansed.

3. If a wound needs cleansing, then drinkable tap water suffices. This should be applied in a patient-friendly way using lukewarm water and a gentle squirt.

4. The use of disinfectants to cleanse acute wounds is dissuaded.

5. Bathing of wounds in whatever solution, even water, should not be part of wound cleansing.

Pain control

6. Consider psychosocial, local, and systemic forms of analgesic treatment.

7. Use the WHO pain ladder when considering a systemic analgesic treatment. Any prescription should be in agreement with the patient's preference.

8. The use of NSAID-containing dressings to treat continuous wound pain is dissuaded.

9. Lidocaine or prilocaine is considered the first-choice drug to avoid acute-wound pain during manipulation or surgical closure.

10. Lidocaine or prilocaine should preferably be administered as infiltration anesthesia.

11. EMLA® cream should be applied for indications as defined in the instruction leaflet: intact skin, genital mucosa, or crural ulcers.

12. When the patient is afraid of needles, lidocaine or prilocaine might be administered cutaneously, but be aware of the time to take effect (30–45 min).

13. Mild and moderate pain (VAS or NRS score between 1 and 6) can best be treated with paracetamol and an NSAID.

14. In high-risk patients (e.g., above 70 years of age) the prescription of NSAIDs is dissuaded.

15. If the first two steps of the WHO ladder do not suffice to treat moderate-to-severe pain (VAS or NRS score between 3 and 7), then use a strong-acting opioid (step 3).

16. Prescribe only one strong-acting opioid per healthcare institution and carry a limited range of these opioids in stock.

Instructions to the patient

17. The application of wound dressings on primarily closed wounds is dissuaded. A dressing may be considered

a. To absorb exudate or transudate.

b. In case the patient prefers this, after being informed it will not prevent a wound infection and may hurt when being removed or changed.

18. Showering the wound area (for <10 min) is allowed 24 h after surgical wound closure in a hospital, if the patient wishes to do so.

19. If there is a prosthesis beneath the wound, then showering the wound area (for <10 min) is allowed after 48 h if there are no signs of infection and the treating surgeon agrees.

20. The treating surgeon should instruct patients about when and how to mobilize. This may depend on the patient's preference, location of the wound, healing progress, and type of surgery performed.

21. Patients should be advised to protect superficial wounds (e.g., grazes) against exposure to ultraviolet light for at least 3 months.

Wound care materials

22. Covering a primarily closed wound using a simple dressing material is indicated only in case of wound leakage, to protect against adherence of the wound to clothes, or if the patient so wishes, for example, when he does not want to see the wound.

23. For wounds healing by secondary intention, a nonadhesive dressing should be applied. The choice of dressing should be determined by the patient's circumstances (e.g., change frequency, leakage, or pain).

24. For donor-site wounds after split-skin grafting, a hydrocolloid is advised to promote wound healing, while a film dressing is a good alternative.

25. A locally infected wound may be treated with iodine or honey, after adequate cleansing. As none of the antiseptics excels, iodine or honey is recommended. The choice may be based on product availability, experience with and knowledge about the product, and their discerning characteristics.

26. In future studies on antiseptics, iodine or honey should be one of the study arms.

27. Leaking wounds deserve an absorbing dressing that is changed depending on the amount of exudate. Additional absorbing capacity is required when leakage is expected to be substantial or when demanded by the patient's circumstances.

28. Prolonged or substantial leakage also calls for exploration of its cause.

29. In bite wounds, a nonadhesive or absorbing dressing is advised. Small bite wounds may dry and heal uncovered.

30. Patients with bite wounds should be instructed about signs of infection.

31. Superficial, nonleaking grazes may not need a dressing or be covered with paraffin or a plaster. Consider using an (semi) occlusive dressing if the wound is painful.

32. Leaking grazes may be covered with a nonadhesive dressing (paraffin gauze or silicone dressing) and an absorbing dressing.

33. Skin tears and flap wounds should be covered, after appropriate cleansing and fixation of the detached skin, with a nonadhesive dressing, which should preferably not be changed within 7 days. If a skin flap is resected, then a nonadhesive dressing should be used that should remain in situ as long as possible.

Organization of acute-wound care

34. To classify the status of the wound, the Red-Yellow-Black scheme can be used, including the assessment of the wound moistness (wet, moist, or dry).

35. In addition to the RYB scheme, the TIME model is recommended to facilitate a uniform and systematic wound care policy.

36. To ensure continuity in the chain of care, the following wound care aspects are vital to be recorded in writing, preferably by a wound care specialist, and to be handed over in case of referral.

a. Wound characteristics

b. Patient characteristics (e.g., comorbidity)

c. Diagnosis and treatment plan

d. Goals to be reached

e. Tasks and responsibilities of caregivers involved

f. Indications when to refer and to whom

g. Who has performed the treatment and who is responsible

37. Drugs for patients with acute wounds may be prescribed by physicians, nursing specialists, or physician assistants, according to prevailing legislation.

38. The wound care policy should only be performed by qualified and capable professionals.