Management of Deep Wounds with Exposed Tendon or Bone

Assessment and Rationale for Hospital Referral

A patient with a deep wound exposing tendon or bone should be sent to the hospital immediately for evaluation and treatment, even in the absence of infection signs, as these structures require specialized care to prevent complications and preserve limb function 1
The exposure of tendon or bone represents a severe wound that requires urgent specialized care, regardless of infection status 1
Wounds that probe to bone or tendon indicate severe tissue damage that may require imaging studies and specialized treatment approaches 2, 3
Even without current signs of infection, exposed tendon and bone are at high risk for developing deep infections that can lead to osteomyelitis, septic arthritis, or tendonitis 4

Comprehensive wound assessment using sterile, blunt metal probing to determine depth and extent of the wound is necessary 2, 3
Appropriate imaging (radiographs, MRI) to evaluate bone involvement and detect any deep tissue abscesses is required 2, 3
Surgical debridement to remove non-viable tissue and reduce bacterial load is a crucial step in management 2, 5

Development of deep infections including osteomyelitis, which is difficult to treat and may require prolonged antibiotic therapy, can occur if treatment is delayed 4
Increased risk of amputation if infection progresses to involve bone or joint spaces is a potential complication of delayed treatment 6, 7
Functional impairment due to tendon damage or joint involvement can result from delayed treatment 4

Even in the absence of obvious infection signs, exposed bone and tendon represent a severe wound requiring specialized care, according to the American College of Surgeons 1
The presence of a "stony feel" when probing the wound indicates bone contact and requires urgent evaluation, as recommended by the Infectious Diseases Society of America 2
Assuming that absence of infection signs means the wound can be managed conservatively is a common pitfall to avoid, as exposed tendon/bone always requires specialized care 1
Aggressive debridement in non-specialized settings can worsen the wound and impair skin closure, and closing infected wounds can lead to abscess formation and deeper infection, as warned by the Clinical Infectious Diseases society 4