Management of Plant Thorn Injuries

Initial Wound Management

Irrigate the wound thoroughly with copious amounts of sterile saline or potable water to remove foreign bodies and contaminants, as recommended by the American College of Emergency Physicians 1
Avoid high-pressure irrigation as this may drive bacteria and plant material deeper into tissue layers, according to the World Journal of Emergency Surgery 2, 3
Remove superficial debris carefully without causing additional tissue damage, and perform deep debridement cautiously to avoid enlarging the wound, as suggested by the Infectious Diseases Society of America 4

Consider 3-5 days of prophylactic antibiotics for deep wounds, wounds in critical locations, patients at elevated infection risk, and patients with implants, as recommended by the World Journal of Emergency Surgery 2, 3
Use Amoxicillin-clavulanate as the first-line antibiotic for broad-spectrum coverage, as suggested by the Infectious Diseases Society of America 4
Add penicillin coverage for anaerobes including Clostridium species for soil-contaminated wounds with tissue damage, as recommended by the American Academy of Orthopaedic Surgeons 5, 6

Do not close infected wounds, and consider wound margin approximation with Steri-Strips followed by delayed primary or secondary closure for fresh, clean wounds, as suggested by the Infectious Diseases Society of America 4
Cover the wound with antibiotic ointment and a clean occlusive dressing to maintain moisture and prevent contamination, as recommended by the American College of Emergency Physicians 1

Administer tetanus toxoid if vaccination is not current or vaccination status is unknown, as recommended by the American College of Emergency Physicians 1

Elevate the injured extremity during the first few days to reduce swelling and accelerate healing, as suggested by the Infectious Diseases Society of America and the American College of Emergency Physicians 1, 4

Follow up within 24 hours either by phone or office visit, and monitor for signs of infection, as recommended by the Infectious Diseases Society of America and the American College of Emergency Physicians 1, 4