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Medical Author:

Benjamin Wedro, MD, FACEP, FAAEM

Benjamin Wedro, MD, FACEP, FAAEM

Dr. Ben Wedro practices emergency medicine at Gundersen Clinic, a regional trauma center in La Crosse, Wisconsin. His background includes undergraduate and medical studies at the University of Alberta, a Family Practice internship at Queen's University in Kingston, Ontario and residency training in Emergency Medicine at the University of Oklahoma Health Sciences Center.

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Medical Editor:

Charles Patrick Davis, MD, PhD

Charles Patrick Davis, MD, PhD

Dr. Charles "Pat" Davis, MD, PhD, is a board certified Emergency Medicine doctor who currently practices as a consultant and staff member for hospitals. He has a PhD in Microbiology (UT at Austin), and the MD (Univ. Texas Medical Branch, Galveston). He is a Clinical Professor (retired) in the Division of Emergency Medicine, UT Health Science Center at San Antonio, and has been the Chief of Emergency Medicine at UT Medical Branch and at UTHSCSA with over 250 publications.

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Wound Medical Care

• The health care practitioner will make certain that there is no associated injury with the wound (for example, if a person falls on their chin, they may be at risk for a jaw fracture), and that the risk of infection is minimized. Good cosmetic appearance with a thin scar is also a goal, but it is not necessarily the most important goal.
• History is important to understand the circumstances of the injury, because mechanism of injury will significantly affect the care provided. An animal bite will require more medical care than one cause by a fall on the playground.
• It is important to know the circumstances of the injury to decide how dirty the wound might be, and whether there are any potential underlying injuries.
• Individuals with diabetes, poor circulation, on dialysis, or taking medications that can compromise the immune system are at higher risk of infection; and the decision to repair a wound may be affected by the patient's medical history.
• Tetanus immunization status will be required to determine if immunization is required.
• The time frame from when the initial injury occurred, and when medical care is sought is also a consideration. The longer a wound is left open, the higher the risk of infection if it is sutured. The guide for many health care practitioners is between 6 and 12 hours. If the wound is older than 6 to 12 hours, it may not be sutured.
• Lacerations of the extremities including legs, arms, feet and hands may involve tendons, nerves and arteries. Assessing their function is an important part of the physical examination.

Sutures (Stitches) for Wounds

Primary closure: The health care practitioner will clean the wound and then explore the area for foreign bodies or underlying structures that may have been damaged prior to closing the wound with sutures, staples, or surgical glue.

If the wound is too old, too dirty, or if there are other reasons to believe that closing the wound is inappropriate, healing may occur by secondary intention. The wound will be cleaned, dressed, and allowed to heal gradually over time without sutures.

In otherwise healthy people with potentially dirty wounds, a combination of the two techniques may be considered (secondary intention and then primary closure). In this scenario, the health care practitioner will clean and dress the wound. The patient will be asked to return within 3-5 days, and if the wound shows no evidence of infection, it may be closed with sutures, staples, or surgical glue.

Other Wound Dressings

Physiologic dressings such as Tegaderm or Hydrogel may be used to promote healing instead of suturing in the elderly due to their very fragile skin, which makes it difficult to repair lacerations and tears in the skin.

Antibiotics for Wounds

If a wound is cleaned and cared for properly, there is often little need to prescribe antibiotics. However, animal bites, human bites, wounds exposed to river or lake water contamination, or other significantly dirty wounds, antibiotics may be prescribed to prevent infection. Antibiotics may also be prescribed if underlying structures like tendons or bones are involved.