Should a patient with a deep wound exposing tendon or bone be sent to the hospital for further evaluation and treatment?

Management of Deep Wounds with Exposed Tendon or Bone

A patient with a deep wound exposing tendon or bone should be sent to the hospital immediately for evaluation and treatment, even in the absence of infection signs, as these structures require specialized care to prevent complications and preserve limb function. 1, 2

Assessment of Wound Severity

When evaluating a deep wound with exposed tendon or bone:

• The exposure of tendon or bone represents a severe wound that requires urgent specialized care, regardless of infection status 1
• Deep wounds with exposed structures are at high risk for developing infection, tissue necrosis, and functional impairment 2, 3
• The mobility of exposed tendons often leads to chronic inflammation that impedes wound healing, while desiccation of the tendon can lead to progressive necrosis 4

Rationale for Hospital Referral

Immediate hospital referral is necessary because:

• Deep wounds with exposed critical structures require specialized surgical debridement, advanced wound management techniques, and possibly reconstruction 1, 2
• Wounds that probe to bone or tendon indicate severe tissue damage that may require imaging studies and specialized treatment approaches 1
• Even without current signs of infection, exposed tendon and bone are at high risk for developing deep infections that can lead to osteomyelitis, septic arthritis, or tendonitis 1
• Specialized wound assessment techniques available in hospital settings are needed to determine the full extent of the wound and involvement of deeper structures 1

Hospital-Based Management Approach

At the hospital, the patient will receive:

• Comprehensive wound assessment using sterile, blunt metal probing to determine depth and extent of the wound 1
• Appropriate imaging (radiographs, MRI) to evaluate bone involvement and detect any deep tissue abscesses 1
• Surgical debridement to remove non-viable tissue and reduce bacterial load 1
• Specialized wound care techniques for exposed structures, which may include:
  • Advanced dressings or dermal templates to protect exposed structures 2, 5
  • Negative pressure wound therapy to promote granulation tissue formation 2, 3
  • Possible skin grafting or flap procedures for definitive coverage 2, 6

Complications of Delayed Treatment

Failure to seek hospital care for wounds with exposed tendon or bone can lead to:

• Progressive tendon necrosis due to desiccation of the exposed structure 4
• Development of deep infections including osteomyelitis, which is difficult to treat and may require prolonged antibiotic therapy 1
• Increased risk of amputation if infection progresses to involve bone or joint spaces 1
• Functional impairment due to tendon damage or joint involvement 1

Special Considerations

• Even in the absence of obvious infection signs, exposed bone and tendon represent a severe wound requiring specialized care 1
• The presence of a "stony feel" when probing the wound indicates bone contact and requires urgent evaluation 1
• Wounds with exposed structures often require advanced treatment modalities that are not available in outpatient settings 2, 3
• Preservation of maximal limb length and function requires early intervention with specialized techniques 5

Common Pitfalls to Avoid

• Assuming that absence of infection signs means the wound can be managed conservatively - exposed tendon/bone always requires specialized care 1
• Delaying referral while attempting outpatient management - this increases risk of infection and tissue necrosis 4
• Aggressive debridement in non-specialized settings - this can worsen the wound and impair skin closure 1
• Closing infected wounds - this can lead to abscess formation and deeper infection 1

Remember that early intervention for wounds with exposed tendon or bone is critical for preserving function and preventing serious complications, even when infection is not yet apparent 1, 2.