Healthy 30-year-old male school-teacher thrown in MVA, left for dead. Sister-in-law rushed to scene, saw he was breathing, demanded care at regional hospital (three hours away). Lacerations. One 25cm long on left flank sutured cursorily at hospital. Multiple contusions, extensive road rash, including 3cmx6cm forehead abrasion with 1cmx1cm exposed cranium. No X-Rays done at hospital, wounds not dressed. Sister-in-law (clinic-worker) obtained, had dexamethasone administered. Regained consciousness four days later; to clinic for outpatient care. By then, several wounds filled with thick yellow exudate. Significant pain.

Polymeric membrane dressings relieve pain (presumably inhibit nociceptors). Also, ingredients draw, concentrate healing substances from body into wound bed to promote rapid healing, facilitate autolytic debridement by loosening bonds. Dressings contribute moisture while absorbing excess, therefore recommended for exposed tendons and bones as well as heavily exudating wounds. Since possible fracture, silver filler to prevent infection at cranium until bone completely covered.

Treatments: antibiotic, acetaminophen, prayer. Forehead cleaned: saline. Silver polymeric membrane wound filler into cavity, covered with plain polymeric membrane dressing, changed daily. Later, flank wound dehisced revealing gravel/debris deep inside laceration. Cleaned, covered with plain polymeric membrane dressings. By tenth day, plain wound filler replaced silver in forehead cavity; at one month extra-thick polymeric membrane dressings used without filler, dressings every-other-day. Standard thickness dressings next week. Last two weeks, polymeric membrane silver 1” x 1” dots used for convenience.

Forehead wound remained appropriately moist, including area over exposed bone. Granulation tissue formed along edges, quickly migrating to cover bone. Forehead wound filled without infection, closing completely two months after initial polymeric membrane dressings. Flank wound closed completely three weeks after cleaning.

Bone remained moist and full-thickness forehead wound healed completely with minimal scarring in two months.