From the Research
For a laceration on a finger that occurred more than 72 hours ago, the wound should no longer be sutured closed as this increases infection risk. The most recent and highest quality study on laceration management is from 2019 1, which provides an update on the current practices in emergency department laceration management. However, the key principles of wound care remain the same. Clean the wound thoroughly with mild soap and water, then apply an antibiotic ointment like Bacitracin or Neosporin and cover with a clean bandage. Change the bandage daily and monitor for signs of infection such as increasing redness, warmth, swelling, pus, red streaks extending from the wound, or fever.
Some key points to consider in the management of such wounds include:
- Keeping the wound moist with antibiotic ointment to promote healing by secondary intention (healing from the inside out) 2
- Elevating the finger when possible to reduce swelling
- Seeking medical attention immediately if the wound is deep, involves a joint, has visible tendon or bone, or shows signs of infection
- Verifying tetanus status and providing a booster if indicated, typically if the last tetanus shot was more than 5 years ago with a dirty wound or more than 10 years ago with a clean wound
The use of prophylactic antibiotics in laceration management is not universally recommended and should be considered on a case-by-case basis. A study from 2012 3 found that a 2-day regimen of prophylactic antimicrobial agents was as effective as a 5-day regimen in preventing surgical site infection in patients with simple traumatic contaminated wounds or lacerations. However, another study from 1997 4 suggested that antibiotics may not be necessary in the surgical management of upper limb lacerations, provided meticulous surgical debridement is performed.
Given the potential for infection and the importance of appropriate wound care, it is crucial to monitor the wound closely and seek medical attention if any signs of infection develop. The most recent study from 2023 5 highlights the successful use of amoxicillin-clavulanate acid in treating a patient with a severe wound infection, underscoring the importance of appropriate antibiotic coverage when necessary.