Management of Superficial Hand Lacerations
Initial Assessment and Preparation
- The American College of Surgeons recommends obtaining 3-view hand radiographs to detect fractures, foreign bodies, or bone involvement, even in seemingly superficial wounds 1
- Active range of motion of all digits should be tested to assess for flexor pollicis longus tendon laceration requiring surgical referral rather than simple closure 1
- Neurovascular injury should be examined by assessing sensation in the radial nerve distribution and capillary refill of the thumb 1
Wound Closure and Suturing
- The American College of Emergency Physicians suggests that superficial lacerations should be sutured after proper irrigation to achieve optimal healing and function 1
- Puncture wounds should never be sutured as this traps bacteria and dramatically increases infection risk 2
- Heavily contaminated lacerations should be left open to heal by secondary intention 2
- Subcuticular continuous sutures should be used rather than interrupted transcutaneous sutures to reduce superficial wound dehiscence 3, 4
- Slowly absorbable monofilament suture material, such as 4-0 or 5-0 poliglecaprone, should be chosen to maintain 50-75% tensile strength after one week and eliminate the need for suture removal 3, 4
Infection Prevention and Management
- Amoxicillin-clavulanate 625 mg orally three times daily for 5-7 days should be prescribed to prevent polymicrobial infection, as palmar wounds are high-risk for contamination 1
- Tetanus status should be verified immediately and 0.5 mL tetanus toxoid intramuscularly administered if last dose was >10 years ago or unknown 1, 2
- The hand should be elevated during the first few days to reduce inflammation and promote healing 1
- The wound should be covered with antibiotic ointment and occlusive dressing to maintain a moist environment 1