From the Research
Care management for a palmar fifth digit laceration involves thorough wound cleaning, appropriate closure, and follow-up care, with the goal of achieving optimal cosmetic results and minimizing the risk of infection, as supported by the most recent evidence 1. The care management plan should include:
- Thorough wound cleaning with sterile saline or mild antiseptic solution, removing any debris or foreign material
- Local anesthesia using 1-2% lidocaine (without epinephrine for digits) administered before exploration and repair
- Careful examination of the wound to assess for tendon, nerve, or vascular injury, particularly checking flexor tendon function
- Closure with 5-0 or 6-0 non-absorbable sutures like nylon or polypropylene, maintaining proper digital alignment, for simple lacerations
- Application of antibiotic ointment and a non-adherent dressing, followed by a bulky protective dressing
- Consideration of prophylactic antibiotics like cephalexin 500mg four times daily for 5-7 days if the wound is contaminated or deep
- Tetanus prophylaxis administration if needed
- Elevation of the hand above heart level to reduce swelling, and recommendation of acetaminophen or ibuprofen for pain management
- Suture removal in 10-14 days
- Patient instruction to return immediately if signs of infection develop, including increasing pain, redness, swelling, or purulent drainage
- Early range of motion exercises to prevent stiffness, with deep lacerations involving tendons or nerves requiring surgical consultation and specialized repair, as highlighted in 2. It is essential to consider the mechanism and severity of the injury, as well as the patient's overall health status, when developing a care management plan, as emphasized in 1.