What is the recommended treatment approach for approximated wound closure in a healthy patient with a clean, minor wound, such as a laceration or incision, without any underlying medical conditions?

Approximated Wound Closure for Clean, Minor Wounds

For healthy patients with clean, minor lacerations or incisions, primary wound closure with sutures, staples, or tissue adhesives is the recommended approach after appropriate wound preparation, with excellent healing outcomes and minimal infection risk when proper technique is employed. 1

Wound Preparation Prior to Closure

Irrigation is the single most critical step before any wound closure method is selected:

• Copious irrigation with sterile normal saline using a 20-mL or larger syringe is recommended for all wounds 2
• There is no evidence that antiseptic irrigation solutions are superior to sterile saline or even tap water for clean wounds 1
• Mechanical cleansing through irrigation is as important as any other intervention in preventing infection 2
• Superficial debris should be removed, but deep debridement is usually unnecessary for clean wounds 3

Primary Closure Methods for Clean Wounds

For clean, minor wounds in healthy patients, multiple closure options are equally effective:

Suturing

• Suturing can be completed up to 24 hours after trauma occurs for most wound sites, allowing adequate time for proper wound preparation 1
• Absorbable sutures are recommended for fascial closure when applicable 3
• Antibiotic-coated sutures may reduce surgical site infections when available 3

Skin Staples

• Skin stapling is an efficient and cost-effective alternative to suture repair for selected lacerations of the scalp, trunk, or extremities (excluding hands and feet) 4
• Stapling is easier and quicker than suture repair at lower overall cost without compromising wound healing or cosmetic results 4
• Only minimal complications (1-2%) were observed with staple closure in emergency department settings 4

Tissue Adhesives

• Tissue adhesives are equally effective for low-tension wounds with linear edges that can be evenly approximated 1
• This method is particularly useful for minor lacerations in cooperative patients 1

Sterile Adhesive Strips (Steri-Strips)

• Sterile adhesive strips represent a quick, cheap, and effective alternative for appropriate wound closure 5
• A prospective study demonstrated a sepsis rate of only 1.4% with total complication rate of 2.7% using this technique 5
• This method is particularly useful when suturing resources are limited 5

Post-Closure Wound Care

Contrary to traditional teaching, wounds can get wet within the first 24-48 hours after closure without increasing infection risk 1:

• Occlusion of the wound is key to preventing contamination 1
• Patients do not need to keep wounds completely dry during the initial healing period 1

Antibiotic Prophylaxis

Prophylactic antibiotics are NOT recommended for most simple, clean wounds in healthy patients 1:

• There is no evidence that prophylactic antibiotics improve outcomes for clean, minor wounds in healthy individuals 1
• Antibiotics should be reserved for high-risk wounds or high-risk patients 3

Tetanus Prophylaxis

Tetanus toxoid should be administered as soon as possible to patients who have not received a booster in the past 10 years 1:

• Tdap is preferred over Td if the patient has not previously received Tdap 3
• This is a mandatory consideration for all traumatic wounds 3

Critical Pitfalls to Avoid

The most common errors in wound closure include:

• Inadequate irrigation - mechanical cleansing is as important as any other intervention 2
• Closing wounds under tension - this increases risk of dehiscence and poor healing 3
• Unnecessary use of prophylactic antibiotics in clean wounds, which contributes to antibiotic resistance 1
• Keeping wounds excessively dry - modern evidence supports early moisture exposure 1

Special Considerations

Facial wounds warrant special attention:

• Facial wounds can be closed primarily even in contaminated settings after copious irrigation and cautious debridement to achieve optimal cosmetic outcomes 2
• Infection rates remain <1% with proper management of facial wounds 2

Hand and finger wounds require different management:

• These wounds should generally NOT be primarily closed due to significantly higher infection rates 2, 6
• Wound approximation without formal closure may be acceptable 3