What is the recommended solution for cleaning lacerations?

Cleaning Lacerations: Best Practices

Clean water or normal saline should be used to irrigate lacerations, as they are equally effective and safe for wound cleansing. 1, 2

Irrigation Technique

• Irrigation Method:

  • Use clean tap water or sterile saline for wound irrigation 1, 2, 3
  • Higher irrigation pressures are more effective than lower pressures 1
  • Higher volumes (100-1000 mL) are better than lower volumes for removing bacterial contamination 1, 4
  • Irrigation should be performed until visible debris is removed from the wound

• Evidence Strength:

  • Multiple clinical trials have demonstrated that tap water is as effective as (or potentially better than) sterile saline for wound irrigation 1, 2, 3, 5
  • A Cochrane review found no significant difference in infection rates between tap water and sterile saline for wound cleansing 2

What to Avoid

• Do not use:
  • Antiseptic agents like povidone-iodine or hydrogen peroxide, which can damage healthy tissue and impair healing 4
  • Antimicrobial dressings for routine laceration care (only use for infected wounds) 1
  • Topical antimicrobial treatments, as they may promote fungal infection or antimicrobial resistance 1

Special Considerations

• Deep Wounds:

  • For deep dog bites or heavily contaminated wounds, more thorough irrigation is critical 4
  • Do not primarily close deep animal bites due to high infection risk 4

• Wound Dressing:

  • After cleaning, cover superficial traumatic abrasions with a clean occlusive dressing to keep the wound moist and prevent drying 1
  • For simple lacerations, a sterile, inert dressing is sufficient 1

• Timing Considerations:

  • Suturing can be completed up to 24 hours after trauma occurs, depending on the wound site 1, 6
  • Facial wounds can be closed primarily if there has been meticulous wound care and copious irrigation 4

Follow-up Care

• Monitor for signs of infection (redness, swelling, increased pain, foul-smelling drainage, or fever) 4
• Remove dressing and seek medical care if signs of infection develop 4

Common Pitfalls to Avoid

1. Inadequate irrigation volume: Using too little fluid for cleaning can leave contamination behind
2. Harmful cleaning agents: Using antiseptics that damage tissue rather than clean tap water or saline
3. Delayed cleaning: Waiting too long to clean a laceration increases infection risk
4. Overlooking foreign bodies: Failing to thoroughly examine the wound for debris or foreign material
5. Primary closure of high-risk wounds: Closing heavily contaminated wounds or animal bites increases infection risk

The evidence consistently shows that simple, accessible cleaning methods (tap water or saline) are effective for most lacerations, and complex antiseptic solutions offer no additional benefit while potentially causing tissue damage.