What are the dressing instructions for a laceration on the palm?

Dressing Instructions for Palm Lacerations

For a laceration on the palm, apply a clean occlusive dressing with a non-adherent contact layer directly against the wound, followed by an absorbent secondary dressing, and secure with tubular bandage rather than adhesive tape to prevent further skin damage. 1

Initial Wound Care

1. Wound Cleansing:

   • Irrigate the wound thoroughly with warm sterile saline or clean potable water until all visible debris is removed 1
   • Use sufficient volume (100-1000 mL) with adequate pressure 1
   • Avoid additives such as soap or antiseptics as they provide no additional benefit and may impair healing 1

2. Wound Assessment:

   • Evaluate depth, size, and location of the laceration
   • Check for foreign bodies, tendon or nerve involvement (particularly important in palm injuries) 2
   • Assess tetanus immunization status and update if needed 1

Dressing Application

1. Primary Layer:

   • Apply a thin non-adherent contact layer directly to the wound surface (e.g., Mepitel™ or Telfa™) 3, 1
   • This prevents the dressing from sticking to the wound and causing damage during changes

2. Secondary Layer:

   • For exudative wounds: Use foam dressings or alginates to absorb exudate 1
   • For dry wounds: Consider applying a greasy emollient such as 50% white soft paraffin with 50% liquid paraffin 3

3. Securing the Dressing:

   • Use tubular bandage rather than adhesive tape to secure dressings 1
   • This is especially important for palm wounds to allow some movement while protecting the wound

4. Special Considerations for Palm Wounds:

   • Position the hand with slight wrist extension to reduce tension on the wound 4
   • Ensure dressing allows for wound inspection while providing protection from external trauma 1

Follow-up Care

1. Dressing Changes:

   • Change the dressing every 24-48 hours initially, or sooner if it becomes saturated 1
   • Maintain a moist wound environment to promote healing 4

2. Wound Monitoring:

   • Monitor for signs of infection: increasing redness, swelling, warmth, pain, purulent drainage, or fever 1
   • Elevate the hand when possible to reduce swelling 1

3. Activity Restrictions:

   • Limit use of the affected hand to prevent wound dehiscence
   • Avoid activities that could contaminate the wound

When to Seek Medical Attention

• If the wound becomes increasingly red, swollen, or painful 1
• If purulent drainage develops 1
• If fever or other systemic symptoms occur 1
• If there is concern about functional impairment (difficulty moving fingers) 2

Pitfalls and Caveats

• Avoid excessive pressure: Palm dressings that are too tight can compromise circulation
• Monitor for compartment syndrome: Especially with deep palm lacerations
• Consider functional impact: Ensure dressing allows for some finger movement to prevent stiffness
• Special attention to wound edges: Palm skin is thick and wound edges may separate easily if not properly dressed

By following these guidelines, palm lacerations can be effectively managed to promote healing while minimizing the risk of infection and maintaining hand function.