What are the steps for examining and managing a lacerated wound?

Lacerated Wound Examination

Cleanse the wound with sterile normal saline, perform systematic visual inspection with adequate lighting and analgesia, measure wound dimensions, probe for depth and structural involvement, assess neurovascular function, and document all findings before proceeding with repair. 1

Pre-Examination Preparation

Ensure adequate lighting and patient analgesia before beginning the examination, as inadequate pain control will compromise your ability to perform a thorough assessment 1. Prepare the laceration site with povidone-iodine or chlorhexidine gluconate (if iodine-allergic) 2, 1.

Systematic Visual Inspection

• Measure and record the wound size (length, width, depth) to establish a baseline for healing assessment 1
• Examine the external aspect of the wound area for abrasions, bruising, or other associated injuries 1
• Look specifically for signs of contamination or foreign material 2

Wound Cleansing

Cleanse wounds with sterile normal saline—there is no need for iodine- or antibiotic-containing solutions for irrigation 2. Evidence shows that potable tap water is equally safe and does not increase infection risk compared to sterile saline 3, 4. Remove superficial debris during cleansing 2.

Deep Tissue Assessment

• Use a sterile, blunt metal probe to measure wound depth and extent, which is critical for detecting serious complications 1
• Determine if there is communication with joint cavities or tendon sheaths 1
• Assess whether debridement is needed—deeper debridement should be done cautiously to avoid enlarging the wound and impairing skin closure 2

Critical Findings Requiring Immediate Action

• Pain disproportionate to the severity of injury but located near a bone or joint suggests periosteal penetration and requires urgent specialist evaluation 2, 1
• Exposed tendon or bone requires immediate hospital referral for specialized care, even without infection signs 1
• Hand wounds are often more serious than wounds to fleshy parts of the body and warrant heightened concern 2

Neurovascular Assessment

• Check for presence or absence of distal pulses 1
• Assess for nerve injury by testing sensation and motor function distal to the wound 1
• Weak or absent pulses, cardiac compromise, or crush-type injuries require either immediate surgical exploration or rapid CT angiography 1

Assessment for Complications

Look for signs suggesting:

• Septic arthritis, osteomyelitis, subcutaneous abscess formation, tendonitis, or bacteremia 2
• Nerve or tendon injury or severance 2
• Compartment syndromes 2

Documentation Requirements

Accurately report all findings, including:

• External appearance of the wound area 1
• Presence of abrasions or bruising 1
• Status of surrounding tissues 1
• Depth and extent of tissue involvement 1
• Any exposed structures 1
• Mechanism of injury (especially important for bite wounds) 2

Special Considerations for Bite Wounds

If the wound is from a bite:

• Infected wounds should not be closed 2
• Suturing wounds early (<8 hours after injury) is controversial; approximation of margins by Steri-Strips with delayed primary or secondary closure is prudent 2
• Facial wounds are an exception and can be closed primarily if seen by a plastic surgeon, provided there has been meticulous wound care, copious irrigation, and prophylactic antibiotics 2

Tetanus and Infection Prevention

• Ensure tetanus prophylaxis status is current—if outdated or unknown, administer 0.5 mL tetanus toxoid intramuscularly 2, 5
• Consider antibiotic therapy for human or animal bites, wounds in risk areas, and contaminated wounds 5