Post-Operative Documentation After Hand Laceration Repair
After suturing a hand laceration with a normal physical exam, document intact neurovascular status distal to the wound, full range of motion of all digits, normal capillary refill (<2 seconds), intact two-point discrimination, and normal motor function of all tendons. 1
Essential Physical Exam Findings to Document
Neurovascular Assessment
- Sensory function: Test and document two-point discrimination in all affected digits, comparing to the contralateral hand 1
- Motor function: Document active flexion and extension of all digits, specifically testing flexor digitorum superficialis, flexor digitorum profundus, and extensor tendons depending on wound location 1
- Vascular status: Record capillary refill time (<2 seconds is normal), skin color, temperature, and presence of radial and ulnar pulses 1
Wound Characteristics
- Wound edges: Document that edges are well-approximated without tension, gaping, or signs of ischemia 2
- Surrounding tissue: Note absence of erythema, warmth, swelling, or purulent drainage 2, 3
- Foreign body exclusion: Explicitly state that the wound was explored and no foreign bodies were identified 1
Post-Operative Instructions
Wound Care Protocol
- Keep the wound dry for 24-48 hours after suturing, then gentle washing is acceptable without increasing infection risk 3
- Apply occlusive dressing to prevent contamination, which is the key element in preventing wound infection 3
- Instruct the patient to perform hand hygiene before and after any dressing changes using alcohol-based hand rub or soap and water 4
Activity Restrictions
- Elevate the hand above heart level for the first 48-72 hours to minimize swelling 5
- Rest the arm to prevent postoperative swelling and optimize healing 4
- Avoid submerging the wound in water (no swimming, bathing) until suture removal 4
Warning Signs Requiring Immediate Return
- Increasing pain, redness, warmth, or swelling beyond the first 24 hours 2, 3
- Purulent drainage or foul odor from the wound 2
- Fever >38°C (100.4°F) 3
- Red streaking extending from the wound 3
- Numbness, tingling, or weakness that develops after the initial repair 1
- Persistent hand swelling beyond 1 week that could indicate venous obstruction 4, 5
Mandatory Follow-Up Schedule
48-Hour Wound Check
- All patients must return within 48 hours for wound inspection to detect early infection and optimize outcomes 1
- This visit allows early recognition and active treatment of wound complications 2
Suture Removal Timing
- Hand sutures typically require 10-14 days before removal, depending on wound location and tension 3
- Schedule this appointment at the time of initial repair 2
Common Pitfalls to Avoid
Documentation Errors
- Never document "neurovascular exam intact" without specifying which nerves and vessels were tested 1
- Always explicitly state that foreign bodies were excluded, as failure to identify foreign bodies is a major source of malpractice claims 1
Infection Prevention Failures
- Do not skip hand hygiene instructions—contaminated hands are the predominant mode of transmission of infectious agents 4
- Do not use petroleum-based lotions on hands before or during wound care, as they deteriorate latex gloves 6
Inadequate Follow-Up
- Do not rely on "return if problems" instructions alone—mandate the 48-hour wound check to catch complications early 1
- Do not dismiss persistent swelling beyond 2 weeks, as this may indicate central venous stenosis or deep vein thrombosis requiring urgent evaluation 5
Tetanus Prophylaxis
- Administer tetanus toxoid as soon as possible if the patient has not received a booster in the past 10 years 3