Yeah, you can put it straight on the wound if you like and I'd do that if I were dealling with a very large wound/ I was going to be using the whole lot in one go but if not if you put it on the dressing then it stops the end getting contaminated and so doesn't transfer any debris from that wound to the next you use it on. But yeh, the wound does have to be clean. I think I've seen it's use also on infected wounds but that was when used alongside effective antibiotics and we ALWAYS clean the wound up well and that comes from me, what I've been taught as well as other people who use it who actually don't know much about it. But yeh, it does in itself create an environment great for the wound to heal but alongside that it's also a perfect environment for bacteria to grow so yeh, you do have to be careful with that and dressings that produce a 'moist environment' to enhance healing.
That size cut is large and should really be checked, yes if possible. The blood vessels in that layer are mainly capillaries, some are arterioles, some venules (small veins) but the bigger ones are deeper. Really you do have to apply pressure and try and stop them as soon as possible, not only because of the blood loss but whilst ever a blood vessel is open the chances of bacteria getting in it are quite high from SH and that can lead to infection straight into your bloodstream; septicaemia (AKA blood poisoning) which can kill so yeh, it is still dangerous. The worry is that if the areas get infected though the infection will go straight into your fat causing a cellulitis and can go deeper and spread; that's what can cause huge problems and with cuts that size, the amount of time it takes for them to close you do need to take that on board. If you can't talk then if possible write it down and go and get cuts that size checked out as they really could do with being; the fact that they've wanted to do skin grafts before is a sign of that and the others would be VERY hard to close without some work which does have to be taken on board but not only that but you also need to to remember that cutting that deeply and having widespread scarring can also potentially cause problems in the future as the scarred areas will be tighter and so reduce movement and so any closure possible will not only help now but will help with that.
And yeh, I meant future ones could do with being sutured. Though they can do it later than what is often recommended if needed, I definately wouldn't be happy tackling one that late on without other work done to it before (or a lot of surgical work done at the time but the risks that'll leave with infection and wound breakdown are high and thats only with regards to small wounds) and don't know anyone that would, especially because of the size of it and position.
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