From the Research
For a laceration to the wrist in a 17-year-old boy, I recommend primary closure with sutures after thorough wound assessment and preparation. The goals of laceration repair are to achieve hemostasis and optimal cosmetic results without increasing the risk of infection 1. First, evaluate for underlying tendon, nerve, or vascular injury, as the wrist contains many vital structures. Clean the wound with normal saline or sterile water, and debride any devitalized tissue. For anesthesia, use 1-2% lidocaine with epinephrine (unless contraindicated) injected at wound edges.
Suture Selection and Technique
For the wrist, I recommend using 5-0 or 6-0 non-absorbable monofilament sutures such as nylon or polypropylene for skin closure, as these provide excellent tensile strength and minimal tissue reactivity. Place sutures approximately 3-5 mm apart and 3-5 mm from wound edges. Deep dermal sutures using 4-0 or 5-0 absorbable material like Vicryl may be needed if there is tension.
Post-Closure Care
Remove skin sutures in 10-14 days, as the wrist is a high-movement area requiring longer healing time. After closure, apply antibiotic ointment and a non-adherent dressing. Instruct the patient to keep the wound clean and dry for 24-48 hours, then clean gently with mild soap and water. Elevate the wrist and limit movement to reduce swelling and promote healing. Watch for signs of infection including increasing pain, redness, swelling, or discharge. Tetanus prophylaxis should be administered if the patient's immunization status is not up to date. The use of prophylactic antibiotics is not supported by evidence for simple lacerations 2.
Some key points to consider in laceration repair include:
- Irrigation with potable tap water rather than sterile saline does not increase the risk of wound infection 1
- The use of nonsterile gloves during laceration repair does not increase the risk of wound infection compared with sterile gloves 1
- Wounds heal faster in a moist environment, and therefore occlusive and semiocclusive dressings should be considered when available 1