Preface

There are certain clinical skills basic to most practitioners: physicians, mid-level providers, nurses, wound care technicians, and medics. The care of surface injury and lacerations is one of them. Until the 1980s, suturing and other wound care procedures were
taught at the bedside from one generation to the next. Watch one, do one, teach one,
was a common refrain heard by young students trying to glean knowledge that would
give them the skills to clean, suture, and dress wounds.
With the growth of emergency medicine and its acceptance as a specialty came a
rapid growth of textbooks and educational materials that organized and presented
didactic material necessary for the students and residents training in emergency care.
Wounds and Lacerations, now in its fourth edition, represents an effort to provide students and practitioners with a ready source of information and recommendations to
care for a patient with surface injuries. All care recommendations are the product of the
available evidence, science and literature, to back them up. In cases where no science
exists, consensus of experienced practitioners and the authors is offered as support.
The success of previous editions lends credence to this approach, as well as the straightforward and uncomplicated manner in which the content is presented.
The reader of this new edition will find a change in format and content. Each chapter
will be introduced with the Key Practice Points covered in that chapter. The text has
been edited for greater clarity, and more lists and tables are used for quick and easy
reference. Each chapter has been updated with the most recent available science and
literature. Many illustrations have been updated, and new ones have been added. There
have been significant changes in several content areas. The use of absorbable sutures on
the face and hand is now a common practice. The cosmetic outcome is the same as for
nonabsorbable sutures, and visits for suture removal can be eliminated. The emergence
of community-associated methicillin-resistant Staphylococcus aureus is a new challenge.
The use of emergency department ultrasound to find and remove foreign bodies is
becoming more common. Recommendations for tetanus and rabies prophylaxis have
undergone significant changes.
Although this text originated from practices in the emergency department, it is clear
that wound care crosses many specialties and disciplines. Wound care can take place
in emergency departments, clinics, practitioners offices, aid stations, and even in the
field. Where this text is used and who uses it have no limits. If it can benefit one patient,
under whatever circumstance, then it is a success.
Alexander T. Trott, MD

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