## Management of Contaminated Abrasions **Key Point:** The primary goal in abrasion management is prevention of infection and permanent tattooing (traumatic tattooing) by removing embedded foreign material. ### Immediate Management Steps 1. **Cleansing and Foreign Body Removal** - Thorough mechanical cleansing under local or regional anesthesia is mandatory - Removal of dirt, gravel, and other foreign material prevents permanent discoloration - This must be done as soon as possible after injury (within hours) 2. **Tetanus Prophylaxis** - Abrasions are considered contaminated wounds - Tetanus toxoid or immunoglobulin as per immunization status 3. **Topical Management** - Apply antibiotic ointment after cleansing - Cover with non-adherent dressing - Keep wound moist to promote healing and reduce scarring **High-Yield:** Delay in removal of embedded foreign material (>24 hours) results in permanent tattooing of the skin, which is cosmetically unacceptable and difficult to reverse. **Clinical Pearl:** The "road rash" appearance from motor vehicle accidents requires aggressive early debridement. Patients often remember this as a defining feature of their injury if not managed properly. ### Why CT/Imaging Is Not First-Line Here While head and cervical spine imaging may be needed based on mechanism and neurological examination, the stable vital signs and absence of head injury signs make wound management the priority. Imaging can proceed in parallel or after initial wound care. **Mnemonic: ABRASION Management — CLEAN** - **C**leanse thoroughly under anesthesia - **L**ocal anesthetic for pain control - **E**mbedded material removal (critical) - **A**ntibiotic ointment application - **N**on-adherent dressing [cite:Park 26e Ch 8]
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