Recommended Treatment for Cut Wounds
The recommended treatment for cut wounds includes thorough wound cleansing with sterile normal saline, removal of superficial debris, and covering with a clean occlusive dressing and/or topical antibiotic to keep the wound moist and prevent drying. 1
Initial Wound Assessment and Cleaning
- Wounds should be thoroughly cleansed with sterile normal saline (no need for iodine or antibiotic-containing solutions) and superficial debris should be removed 1
- Tap water is as effective as other irrigation solutions in reducing infection rates 1
- Body temperature saline is more comfortable for patients than cold saline 1
- Soap and water can be more effective than irrigation with saline alone for cleaning wounds 1
Wound Closure Considerations
- Suturing wounds early (less than 8 hours after injury) remains controversial 1
- For wounds that aren't closed primarily, approximation of margins using Steri-Strips and subsequent closure by either delayed primary or secondary intent is prudent 1
- Facial wounds are an exception and can be closed primarily if there has been meticulous wound care, copious irrigation, and administration of prophylactic antibiotics 1
- Infected wounds should not be closed 1
Wound Dressing
- After cleaning, superficial traumatic wounds should be covered with a clean occlusive dressing and/or a topical antibiotic that keeps the wound moist and prevents drying 1
- Petrolatum-based ointments like Aquaphor Healing Ointment have demonstrated equivalent efficacy for wound healing as antibiotic ointments, without the risk of allergic contact dermatitis or contributing to antibiotic resistance 2, 3
- Studies have shown that petrolatum-based ointments can provide fast and effective improvements in several wound healing parameters compared with antibiotic-containing treatments 2
Antibiotic Use
- Antibiotic therapy is indicated only for contaminated or dirty wounds (class III and IV) 1
- Clean wounds (class I) and clean-contaminated wounds (class II) generally do not require antibiotic therapy 1
- Preemptive early antimicrobial therapy for 3-5 days is recommended only for patients who: 1
- Are immunocompromised
- Are asplenic
- Have advanced liver disease
- Have preexisting or resultant edema of the affected area
- Have moderate to severe injuries, especially to the hand or face
- Have injuries that may have penetrated the periosteum or joint capsule
Special Considerations
- Tetanus prophylaxis should be administered to patients without toxoid vaccination within 10 years 1
- For wounds with high risk of infection, an antimicrobial agent active against both aerobic and anaerobic bacteria such as amoxicillin-clavulanate may be considered 1
- Elevation of the injured body part, especially if swollen, accelerates healing 1
- Follow-up within 24 hours either by phone or during an office visit is recommended for significant wounds 1
Complications to Monitor
- Infectious complications of wounds may include septic arthritis, osteomyelitis, subcutaneous abscess formation, tendonitis, and rarely bacteremia 1
- Pain disproportionate to the severity of injury but located near a bone or joint should suggest periosteal penetration 1
- Hand wounds are often more serious than wounds to fleshy parts of the body and may require more aggressive management 1