The diagnostic work-up is based on history-taking, inspection and assessment of functioning. Experience and intuition form the cement that holds these building blocks together.
- The most essential questions to be asked when taking the history, concern the immediate cause (what exactly happened and under which circumstances), timing (when it happened), any complicating factors (diabetes, haemophilia, medication, imminent shock) and tetanus prevention.
- It may be necessary to clean the wound in order to inspect it. If the wound appears to be one which will require primary wound closure using a needle and thread, local anaesthetic can be applied immediately to ensure that cleaning and inspection are as painless as possible. For further details refer to the Minor Surgery edition in this series.
- In some wounds, the tissue damage may be far more serious than suggested by the initial appearance. For example, in the case of ruptures, sprains, stab, shot and burn wounds, fractures, irradiation and electrical injuries. If there are no clear contraindications, and if possible nerve, muscle, tendon or ligament damage is suspected, a functional assessment should be carried out. Loss of feeling with a burn wound indicates severe (third degree) tissue damage.