title: They had me in stitches: a Grand Canyon river guide's case report and a review of wilderness wound management literature.
abstract: We present a case of failed conservative management of a traumatic wound sustained in a wilderness setting. The patient was initially treated with a povidone-iodine scrub, suture closure, and expectant management by 2 physicians who were paying clients on a multiday river rafting expedition. Empiric antibiotic coverage and irrigation of the dehisced wound were initiated several days after initial treatment. The patient arranged his own evacuation 8 days after injury. Hospitalization, intravenous (IV) antibiotics, and surgical debridement with wound vacuum placement led to a full recovery. This case presents several common wound care pitfalls. The sequelae to these pitfalls are more dramatic in a wilderness setting and underscore the importance of early aggressive management and considering prompt evacuation when treating wounds sustained in the wilderness.
authors.affiliation: UCSF-Fresno Medical Education Program, Fresno, CA. Electronic address: sspano@gmail.com.
authors.forename: Susanne J
authors.initials: SJ
authors.lastname: Spano
authors.affiliation: Arizona Raft Adventures (AzRA), Flagstaff, AZ.
authors.forename: Brad
authors.initials: B
authors.lastname: Dimock
mesh_terms: D003646:Debridement; D006801:Humans; D007869:Leg Injuries / Q000628:therapy*; D008297:Male; D011206:Povidone-Iodine / Q000627:therapeutic use; D045483:Rivers; D007507:Therapeutic Irrigation; D055813:Wilderness Medicine / Q000379:methods*; D014945:Wound Healing; D014950:Wounds, Penetrating / Q000628:therapy
chemical_list: D011206:Povidone-Iodine
keywords: laceration repair; prophylactic antibiotics; wilderness medicine; wound infection; wound management