What is the appropriate treatment for a 34-year-old patient who cut her hand with a knife last night?

Management of a Hand Knife Cut

For a 34-year-old patient with a knife cut to the hand from last night, thorough wound cleansing, appropriate dressing, and monitoring for signs of infection are the recommended treatment approach to reduce morbidity and prevent complications.

Initial Assessment

• Evaluate the wound for:
  • Depth and extent of the cut
  • Involvement of underlying structures (tendons, nerves, blood vessels)
  • Presence of foreign bodies
  • Signs of infection (redness, warmth, swelling, purulent discharge)
  • Time since injury (in this case, approximately 12-24 hours)

Wound Cleansing

1. Perform hand hygiene before touching the wound 1
2. Gently cleanse the wound with:
   • Sterile saline or clean tap water 2, 3
   • Antimicrobial solution if available
3. Irrigation should be thorough to remove any debris or contaminants 3
4. Avoid using antiseptics like hydrogen peroxide, alcohol, or povidone-iodine as they may be toxic to healing tissues 4

Wound Closure Considerations

• If the wound edges are approximated and the cut is superficial:
  • Apply Steri-Strips or tissue adhesive 2, 3
• If the wound is deeper or gaping:
  • Suturing can be completed up to 24 hours after trauma, depending on wound site 3
  • Consider referral if the wound involves tendons, nerves, or joint spaces

Dressing Application

1. Apply a non-adherent dressing directly to the wound (e.g., Mepitel or Telfa) 2
2. Consider applying a greasy emollient over the wound area 2
3. Apply a secondary foam dressing to collect exudate if needed 2
4. Secure the dressing to maintain position while allowing hand mobility

Infection Prevention

• Monitor for signs of infection:
  • Increasing pain
  • Erythema extending >5cm beyond wound margins
  • Temperature >38.5°C
  • Heart rate >110 beats/minute 2
• Systemic antibiotics are not routinely indicated for simple, clean cuts unless signs of infection develop 2, 3
• Tetanus prophylaxis should be administered if the patient has not received a booster in the past 10 years 3

Pain Management

• Offer appropriate analgesia as needed 2
• Over-the-counter pain medications like acetaminophen or ibuprofen are usually sufficient for minor cuts

Follow-up Instructions

• Keep the dressing clean and dry for the first 24-48 hours 3
• After this period, the wound can get wet without increasing infection risk 3
• Return for wound check within 48 hours 5
• Seek immediate medical attention if signs of infection develop

Special Considerations

• Hand wounds require careful assessment due to the complex anatomy and functional importance
• If there is any concern about deep structure involvement (tendons, nerves, vessels), specialist evaluation may be needed
• For diabetic patients or those with compromised immune systems, more aggressive monitoring and earlier antibiotic therapy may be warranted 2

By following this structured approach to managing a knife cut to the hand, you can promote optimal healing, prevent infection, and minimize the risk of long-term functional impairment.