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«
CLINICAL
MANAGEMENT
ACUTESKIN
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CLINICAL MANAGEMENT OF
ACUTE SKIN TRAUMA
CLINICAL MANAGEMENT OF
ACUTE SKIN TRAUMA
JOEL W. BEAM
Designed cover image: Tinhouse Design
First published 2025
by CRC Press
2385 NW Executive Center Drive, Suite 320, Boca Raton FL 33431
and by CRC Press
4 Park Square, Milton Park, Abingdon, Oxon, OX14 4RN
CRC Press is an imprint of Taylor & Francis Group, LLC
© 2025 Taylor & Francis Group, LLC
This book contains information obtained from authentic and highly regarded sources. While all reasonable
efforts have been made to publish reliable data and information, neither the author nor the publisher can
accept any legal responsibility or liability for any errors or omissions that may be made. The publishers wish
to make clear that any views or opinions expressed in this book by individual editors, authors or contributors
are personal to them and do not necessarily reflect the views/opinions of the publishers. The information or
guidance contained in this book is intended for use by medical, scientific or health-care professionals and is
provided strictly as a supplement to the medical or other professional’s own judgement, their knowledge of
the patient’s medical history, relevant manufacturer’s instructions and the appropriate best practice guidelines. Because of the rapid advances in medical science, any information or advice on dosages, procedures
or diagnoses should be independently verified. The reader is strongly urged to consult the relevant national
drug formulary and the drug companies’ and device or material manufacturers’ printed instructions, and
their websites, before administering or utilizing any of the drugs, devices or materials mentioned in this
book. This book does not indicate whether a particular treatment is appropriate or suitable for a particular
individual. Ultimately it is the sole responsibility of the medical professional to make his or her own professional judgements, so as to advise and treat patients appropriately. The authors and publishers have also
attempted to trace the copyright holders of all material reproduced in this publication and apologize to
copyright holders if permission to publish in this form has not been obtained. If any copyright material has
not been acknowledged please write and let us know so we may rectify in any future reprint.
Except as permitted under U.S. Copyright Law, no part of this book may be reprinted, reproduced, transmitted, or utilized in any form by any electronic, mechanical, or other means, now known or hereafter invented,
including photocopying, microfilming, and recording, or in any information storage or retrieval system,
without written permission from the publishers.
For permission to photocopy or use material electronically from this work, access www.copyright.com or
contact the Copyright Clearance Center, Inc. (CCC), 222 Rosewood Drive, Danvers, MA 01923, 978-750-
8400. For works that are not available on CCC please contact mpkbookspermissions@tandf.co.uk
Trademark notice: Product or corporate names may be trademarks or registered trademarks and are used
only for identification and explanation without intent to infringe.
ISBN: 9781638220664 (pbk)
ISBN: 9781003523055 (ebk)
DOI: 10.1201/9781003523055
Typeset in Minion Pro
by codeMantra
DEDICATION
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To my parents, as your memories and spirit carry me daily.
To athletes, patients, students, and colleagues, thank you for the inspiration and support.
CONTENTS
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Dedication. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . v
Acknowledgments . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .ix
About the Author . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xi
Contributing Authors . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . xiii
Introduction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .xv
Chapter 1 Clinical Presentation and Assessment . . . . . . . . . . . . . . . . . . . . . . . . 1
Chapter 2 Infection Control and Standard Precautions. . . . . . . . . . . . . . . . . . . . .15
Chapter 3
Bernadette Buckley, PhD, LAT, ATC
Chapter 4 Debridement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .49
Chapter 5 Dressings. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .63
Chapter 6 Monitoring and Education. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .103
Chapter 7 Infections and Adverse Reactions. . . . . . . . . . . . . . . . . . . . . . . . . .113
Mario Ciocca, MD
Chapter 8 Clinical Practice Scenarios. . . . . . . . . . . . . . . . . . . . . . . . . . . . . .125
Glossary . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143
Appendix A: Wound Closure. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .147
Appendix B: Wound Care 101 Infographic . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .161
Appendix C: Clinical Application Table . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163
Financial Disclosures . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169
Index . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .171
Cleansing . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .33
ACKNOWLEDGMENTS
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The development of a project such as this requires contributions of time, patience, expertise,
and effort from many individuals. The concept of the textbook began with a conversation with Brien
Cummings at SLACK Incorporated. I thank Brien for his vision and the opportunity to develop the
textbook. Also at SLACK, thanks to Kayla Whittle who came on board to see the project to completion. I extend special gratitude to the contributing authors, Bernadette Buckley, PhD, LAT, ATC and
Mario Ciocca, MD. Bernadette has been involved with me in the wound management journey from
the beginning, providing vision and support in the research and scholarly projects. Completion of
these projects would not have been possible without her assistance. Dr. Ciocca offered his knowledge
and clinical expertise in preparing the infections and adverse reactions chapter, essential components
in the management of acute skin trauma. The photographs and illustrations were made possible
through the efforts of local athletic trainers, contributing authors, and University of North Florida
Clinical and Applied Movement Sciences Department students and colleagues and the University
of North Florida Center for Instruction and Research Technology (CIRT). At CIRT, Shelby Scanlon
guided photo shoots, Brenna Smith created illustrations, and Andy Rush designed a web page for
photograph submission. I would like to thank each of them for their support. Special thanks to
Michael Boyles at CIRT for his creativity and proficiency in the final design of the photographs and
illustrations. These contributions play a significant role in the presentation of the chapters.
ABOUT THE AUTHOR
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Joel W. Beam, EdD, LAT, ATC is a professor and the chair of the Department of Clinical and
Applied Movement Sciences in the Brooks College of Health at the University of North Florida
(UNF) in Jacksonville, Florida. He also teaches within the Master of Science in Athletic Training
Program at UNF. His interest in athletic training began in junior high as a student athletic trainer
and continued through high school. Dr. Beam received his BS degree from East Carolina University
in Greenville, North Carolina; his MEd from Clemson University in Clemson, South Carolina; and
his EdD from UNF. He has 29 years of experience as an athletic trainer at the intercollegiate level
through positions at 4 universities. Dr. Beam has taught athletic training courses at the university
level for over 30 years and has held previous program director and clinical coordinator positions at
UNF. His research focuses on the effectiveness of occlusive dressings on healing rates of standardized abrasions and the implementation of evidence-based acute skin trauma interventions into clinical practice. He has authored book chapters and manuscripts and given numerous presentations at
international and national conferences and symposiums regarding acute skin trauma. Dr. Beam has
also authored the textbook Orthopedic Taping, Wrapping, Bracing, and Padding
.
CONTRIBUTING AUTHORS
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Bernadette Buckley, PhD, LAT, ATC (Chapter 3)
University of North Florida
Jacksonville, Florida
Mario Ciocca, MD (Chapter 7)
University of North Carolina
Chapel Hill, North Carolina
INTRODUCTION
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Trauma and subsequent injury to the skin are frequent with participation in athletic, recreational, and work activities. Various mechanisms of injury can produce abrasions, avulsions,
blisters, lacerations, punctures, and traumatic and postoperative incisions. Proper management
of these injuries is critical to creating an optimal environment to promote healing and lessen the
risk of infection and adverse reactions. Wound management techniques have evolved over the
last 60 years. However, ritualistic interventions and techniques continue in clinical practice today.
Techniques such as cleansing the wound daily with topical antiseptics, using dressings that promote
desiccation of the wound and formation of eschar, performing dressing changes without regard to
the progression of healing, and leaving attached necrotic tissue to the periwound tissue to protect
the wound can increase the risk of adverse reactions. During the 1960s, the discovery of a moist
wound environment with occlusion of the wound challenged many time-honored practices. These
investigations and other researchers examining cleansing, debridement, and dressing interventions
transformed the approach to the management of acute skin trauma.
The paradigm of evidence-based medicine guides appropriate management of acute skin
trauma, and implementation into clinical decision-making and practice can enhance the delivery
of health care services to patients. The overall goal of Clinical Management of Acute Skin Trauma
is to facilitate learning of the knowledge, skills, and clinical abilities required to manage acute
skin trauma effectively. The text is intended for professional athletic training students, practicing
athletic trainers, and other health care professionals responsible for acute wound care. Among students, the text can first be used in the didactic setting and then taken to the clinical setting for skill
development. The material in the text covers the Board of Certification’s Practice Analysis and the
Commission on Accreditation of Athletic Training Education Curricular Content Standards related
to the management of acute skin trauma. Students should have a general knowledge of human and
skin anatomy, wound healing, and the assessment process to integrate the material in the chapters.
Interventions can be introduced and practiced in didactic labs with wound models to provide realworld experiences. Among practicing athletic trainers and other health care professionals, the text
can serve as a practical resource guide for evidence-based practice. For others, the text introduces
evidence-based skin trauma management guidelines for implementation into current practice.
The chapters focus on individual components and interventions for the holistic management
of acute skin trauma. Chapter 1 provides information on the types, etiology, assessment, clinical
presentation, and initial management of acute skin trauma. Chapter 2 presents infection control
guidelines and techniques for facilities and management plans and recommended wound management supplies for facilities and kits. Chapter 3 includes cleansing, Chapter 4 debridement, and
Chapter 5 dressings for acute wounds. These chapters explain and illustrate evidence-based interventions and include the techniques’ goals and objectives, indications, contraindications, and procedures. The selection and application factors to consider for patient management plans and summaries of the evidence are also presented. Chapter 6 discusses patient monitoring and reassessment and
the role of patient education and adherence in the management plan. Chapter 7 explains the causes,
clinical features, treatment, and prevention of infection and adverse reactions. Chapter 8 includes
scenarios to allow students and clinicians the opportunity to bring together individual chapters,
interventions, and factors to develop and revise management plans for patients. Several appendices
are used to enhance the material for the reader. Appendix A presents an overview of wound closure
with sutures and staples. Common suture and staple techniques are illustrated. Appendix B contains
a wound care infographic that can be used for athlete, parent, and guardian education. Appendix C
includes a clinical application table summarizing cleansing, debridement, and dressing techniques
based on wound type. This table allows athletic training students and certified athletic trainers to
carry the guide in athletic training kits and bags in clinical practice settings.
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