Management of Cut Wounds

Initial Wound Assessment and Cleaning

The American College of Cardiology recommends that wounds should be thoroughly cleansed with sterile normal saline and superficial debris should be removed 2
Tap water is as effective as other irrigation solutions in reducing infection rates 1
Body temperature saline is more comfortable for patients than cold saline 1
Soap and water can be more effective than irrigation with saline alone for cleaning wounds 1

Suturing wounds early (less than 8 hours after injury) remains controversial, according to the Infectious Diseases Society of America 2
For wounds that aren't closed primarily, approximation of margins using Steri-Strips and subsequent closure by either delayed primary or secondary intent is prudent, as recommended by the Infectious Diseases Society of America 2
Facial wounds are an exception and can be closed primarily if there has been meticulous wound care, copious irrigation, and administration of prophylactic antibiotics, according to the Infectious Diseases Society of America 2
Infected wounds should not be closed, as stated by the Infectious Diseases Society of America 2

After cleaning, superficial traumatic wounds should be covered with a clean occlusive dressing and/or a topical antibiotic that keeps the wound moist and prevents drying, as recommended by the American Heart Association 1

Antibiotic therapy is indicated only for contaminated or dirty wounds (class III and IV), according to the American Academy of Orthopaedic Surgeons 3, 4, 5
Clean wounds (class I) and clean-contaminated wounds (class II) generally do not require antibiotic therapy, as stated by the American Academy of Orthopaedic Surgeons 3, 4, 5
Preemptive early antimicrobial therapy for 3-5 days is recommended only for patients who are immunocompromised, asplenic, have advanced liver disease, have preexisting or resultant edema of the affected area, have moderate to severe injuries, especially to the hand or face, or have injuries that may have penetrated the periosteum or joint capsule, according to the Infectious Diseases Society of America 6

Tetanus prophylaxis should be administered to patients without toxoid vaccination within 10 years, as recommended by the Infectious Diseases Society of America 6
For wounds with high risk of infection, an antimicrobial agent active against both aerobic and anaerobic bacteria such as amoxicillin-clavulanate may be considered, according to the Infectious Diseases Society of America 6
Elevation of the injured body part, especially if swollen, accelerates healing, as stated by the Infectious Diseases Society of America 2
Follow-up within 24 hours either by phone or during an office visit is recommended for significant wounds, according to the Infectious Diseases Society of America 2

Infectious complications of wounds may include septic arthritis, osteomyelitis, subcutaneous abscess formation, tendonitis, and rarely bacteremia, as stated by the Infectious Diseases Society of America 2
Pain disproportionate to the severity of injury but located near a bone or joint should suggest periosteal penetration, according to the Infectious Diseases Society of America 2
Hand wounds are often more serious than wounds to fleshy parts of the body and may require more aggressive management, as recommended by the Infectious Diseases Society of America 2