Erythematous and Swollen Closed Laceration: Infection Assessment and Management
Your closed laceration with erythema and swelling likely represents a wound infection requiring immediate clinical evaluation, antibiotic therapy, and possible wound exploration—do not wait for symptoms to worsen.
Diagnosing Wound Infection
Clinical diagnosis requires at least two of the following inflammatory signs 1:
- Local swelling or induration (which you have)
- Erythema >0.5 cm around the wound (which you have)
- Local tenderness or pain
- Local warmth
- Purulent discharge
The presence of erythema and swelling alone strongly suggests infection, particularly if these developed after initial wound closure 1. Wound infection represents a disturbed host-bacteria equilibrium that actively inhibits healing processes 2.
Critical distinction: You must exclude other inflammatory causes such as trauma, gout, thrombosis, or venous stasis before confirming infection 1.
Immediate Management Steps
1. Wound Exploration and Assessment
The wound must be opened and explored if infection is confirmed 3:
- Remove any sutures or closure materials to allow drainage
- Irrigate extensively with large volumes of sterile saline using a 20-mL or larger syringe 4, 3
- Avoid antiseptics during irrigation as they damage tissue 3, 5
- Assess for deeper involvement (tendon, bone, foreign bodies) 4
Critical pitfall: Primary closure of contaminated or infected wounds dramatically increases infection rates (27% vs 3% with delayed closure) and prolongs hospital stays 6. The wound should remain open or be approximated only with Steri-Strips 4.
2. Antibiotic Therapy
Start oral antibiotics immediately 4, 3:
- First-line: Amoxicillin-clavulanate 875/125 mg twice daily for 7-10 days (covers common skin pathogens and anaerobes) 4
- Penicillin-allergic: Clindamycin for serious skin and soft tissue infections 7
Watch for progressive redness, increasing pain, fever, or systemic symptoms indicating treatment failure 3, 8.
3. Wound Care Protocol
After irrigation and debridement 3:
- Apply antibiotic ointment to the wound surface
- Cover with clean occlusive dressing to maintain moist environment
- Elevate the affected area for the first few days to reduce inflammation 4, 3
- Change dressings daily and monitor for worsening signs
4. Tetanus Prophylaxis
Administer tetanus toxoid booster if >5 years since last dose for this contaminated wound 4, 3, 5.
Severity Assessment and Red Flags
Mild infection (likely your current state) 1:
- Erythema <2 cm from wound margin
- No systemic symptoms
- Involves only skin/subcutaneous tissue
Seek urgent care immediately if 1, 3:
- Erythema extends ≥2 cm from wound
- Fever >38°C or <36°C
- Heart rate >90 beats/min
- Severe or disproportionate pain (suggests deeper infection)
- Purulent discharge or foul odor
- Failure to improve within 24-48 hours
Follow-Up Requirements
Mandatory reassessment within 24 hours (phone or office visit) to evaluate treatment response 4. Wound infection delays healing and increases risk of chronicity, hospital admission, and limb loss if inadequately treated 9, 8.
Common pitfall: Biofilms in infected wounds are particularly challenging to treat and associated with chronic non-healing 9, 8, 10. Early aggressive management prevents this progression.
Key Clinical Principles
The presence of microorganisms alone does not define infection—clinical inflammatory signs are required for diagnosis 1. However, once infection is established, it actively inhibits every phase of wound healing and requires restoration of the bacteria-host balance through the interventions outlined above 2.