What is the recommended management and suturing technique for a dorsal‑crease laceration of the toe?

Management of Dorsal Crease Toe Lacerations

For a dorsal crease laceration of the toe, perform thorough irrigation and cleansing, then close with simple interrupted sutures using monofilament material, keeping sutures in place for 10-14 days before removal.

Initial Wound Assessment and Preparation

• Ensure adequate lighting and anesthesia before attempting repair, using local infiltration with lidocaine (with or without epinephrine up to 1:100,000 concentration for digits) 1
• Irrigate thoroughly under pressure to completely cleanse the wound, as this is the most important aspect of treating any minor wound to prevent infection 2
• Use sterile saline or tap water for irrigation—there is no evidence that antiseptic irrigation is superior 2
• Examine the wound depth to determine if deeper structures (tendons, bone, joints) are involved, as these require specialist referral 2
• Consider radiographs if there is concern for foreign body or bone involvement 3
• Debride any devitalized tissue and remove gross contamination 3

Suturing Technique for Dorsal Toe Lacerations

• Use monofilament sutures (such as nylon) to reduce bacterial seeding 4
• Place simple interrupted sutures to approximate the skin edges accurately without excessive tension 1, 3
• The dermis provides the greatest strength in wound healing, so accurate approximation of the dermal layer is critical 3
• Avoid placing sutures under excessive tension, as this leads to tissue ischemia, necrosis, and wound dehiscence 1
• Consider using absorbable monofilament sutures (poliglecaprone or polyglyconate) to eliminate the need for suture removal, which is particularly advantageous in toe lacerations where removal can be painful 5

Suture Removal Timing

• Remove sutures at 10-14 days for toe lacerations, as the foot is a high-mobility area requiring longer retention time to prevent wound dehiscence 5
• Do not remove sutures early (before 10 days) even if the wound appears healed superficially, as the dermis requires the full duration to achieve adequate tensile strength 5
• Avoid leaving sutures beyond 14 days, as this increases risk of suture track marks and infection 5

Post-Repair Wound Care

• Occlusive dressing is key to preventing contamination and maintaining a moist wound environment 2
• Patients can get the wound wet within 24-48 hours after suturing without increasing infection risk 2
• Examine the wound 2-3 days after repair to check for early signs of infection, as foot lacerations have higher infection rates than other body sites 5
• Watch for pain disproportionate to injury severity, which may indicate deeper infection or bone involvement 5

Antibiotic Considerations

• Prophylactic antibiotics are not routinely indicated for simple toe lacerations 2
• Reserve antibiotics for high-risk wounds with gross contamination, involvement of deeper structures, or patient comorbidities (diabetes, immunosuppression) 6, 2
• If infection develops, superficial mild infections can be treated with topical agents, while deeper infections require oral antibiotics 2

Common Pitfalls to Avoid

• Do not attempt closure under excessive tension—this is the most common error leading to wound complications 1
• Do not overlook examination of deeper structures, particularly in dorsal toe lacerations where extensor tendons are superficial 2
• Do not forget tetanus prophylaxis if the patient has not received a booster in the past 10 years 2
• Avoid using full-thickness sutures except on palmar and plantar surfaces, as fat and muscle do not support sutures well 3