Local Examination of a Lacerated Wound
Systematic Evaluation Approach
After all laceration injuries, perform a systematic evaluation that includes visual inspection, thorough perineal/wound examination, and digital rectal examination (when anatomically relevant) to detect the full extent of tissue damage. 1
Essential Pre-Examination Steps
- Ensure adequate lighting and patient analgesia before beginning the examination, as inadequate pain control will compromise your ability to perform a thorough assessment 1
- Inform the patient about the need and reasoning for the examination 1
- Prepare the laceration site with betadine or chlorhexidine before detailed examination 1
Visual Inspection Components
- Measure and record the wound size (length, width, depth) to establish baseline for healing assessment 1
- Document the extent of surrounding cellulitis if present 1
- Assess the quality and quantity of any drainage, including color and odor 1
- Examine the external aspect of the wound area for abrasions, bruising, or other associated injuries 1
Deep Tissue Assessment
Use a sterile, blunt metal probe to measure wound depth and extent, which is critical for detecting serious complications 1. This probing technique allows you to:
- Detect any foreign bodies within the wound 1
- Identify soft-tissue abscesses 1
- Determine if there is communication with joint cavities or tendon sheaths 1
- Assess for palpable bone, which has a characteristic "stony feel" when touched with the probe 1, 2
Wound Debridement and Cleaning
- Cleanse wounds with sterile normal saline (no need for iodine- or antibiotic-containing solutions for routine cleaning) 1
- Remove superficial debris during initial examination 1
- Most wounds need debridement, which involves removing both the hyperkeratosis (callus) surrounding a wound and the necrotic tissue and slough from its base 1
- Warn the patient that bleeding is likely and that the wound will appear larger after debridement 1
Critical Findings Requiring Immediate Action
Signs of Deep Structure Involvement
- Pain disproportionate to the severity of injury but located near a bone or joint suggests periosteal penetration and requires urgent specialist evaluation 1
- Exposed tendon or bone requires immediate hospital referral for specialized care, even without infection signs, as these structures are at high risk for osteomyelitis, septic arthritis, or tendonitis 2
- Hand wounds are often more serious than wounds to fleshy parts of the body and warrant heightened concern 1
Vascular Assessment
- Check for presence or absence of distal pulses 1
- Look for signs of vascular injury including pallor, neurological deficits (sensory or motor), or presence of a thrill 1
- Weak or absent pulses, cardiac compromise, or crush-type injuries require either immediate surgical exploration or rapid CT angiography 1
Neurovascular and Functional Testing
- Assess for nerve injury by testing sensation and motor function distal to the wound 1
- Evaluate tendon function through active range of motion testing when safe to do so 1
Documentation Requirements
Accurately report all findings including: 1
- External appearance of the wound area
- Presence of abrasions or bruising
- Status of surrounding tissues
- Depth and extent of tissue involvement
- Any exposed structures (tendon, bone, joint capsule)
This documentation is essential for tracking healing progress and is legally important if the injury involves alleged assault 1.
Common Pitfalls to Avoid
- Do not assume absence of infection signs means a wound with exposed tendon or bone can be managed conservatively - these always require specialized care 2
- Avoid aggressive debridement in non-specialized settings as this can worsen the wound and impair skin closure 2
- Do not close infected wounds, as this leads to abscess formation and deeper infection 2
- Perform digital rectal examination after all vaginal deliveries and perineal trauma as this improves detection of occult anal sphincter injuries 1