Lacerations, abrasions, burns, and puncture wounds are common in the outpatient setting. Because wounds can quickly become infected, the most important aspect of treating a minor wound is irrigation and cleaning. There is no evidence that antiseptic irrigation is superior to sterile saline or tap water. Occlusion of the wound is key to preventing contamination. Suturing, if required, can be completed up to 24 hours after the trauma occurs, depending on the wound site. Tissue adhesives are equally effective for low-tension wounds with linear edges that can be evenly approximated. Although patients are often instructed to keep their wounds covered and dry after suturing, they can get wet within the first 24 to 48 hours without increasing the risk of infection. There is no evidence that prophylactic antibiotics improve outcomes for most simple wounds. Tetanus toxoid should be administered as soon as possible to patients who have not received a booster in the past 10 years. Superficial mild wound infections can be treated with topical agents, whereas deeper mild and moderate infections should be treated with oral antibiotics. Most severe infections, and moderate infections in high-risk patients, require initial parenteral antibiotics. Severe burns and wounds that cover large areas of the body or involve the face, joints, bone, tendons, or nerves should generally be referred to wound care specialists.
- Tap water produces similar outcomes to sterile saline irrigation of minor wounds.
- Noninfected wounds caused by clean objects may undergo primary closure up to 18 hours from the time of injury. Wounds on the head and face may be closed up to 24 hours from the time of injury.
- Tissue adhesives can be used as an alternative for closure of simple, noninfected lacerations in which the wound edges are easily approximated in areas of low tension and moisture.
- Sutures can be uncovered and allowed to get wet within the first 24 to 48 hours without increasing the risk of infection.
- Prophylactic systemic antibiotics are not necessary for healthy patients with clean, noninfected, nonbite wounds.
- Topical antimicrobials should be considered for mild, superficial wound infections. Mupirocin (Bactroban) is preferred for wounds with suspected methicillin-resistant Staphylococcus aureus.
- Nonsuperficial mild to moderate wound infections can be treated with oral antibiotics.
- Most severe wound infections, and moderate infections in high-risk patients, require initial parenteral antibiotics, with transition to oral antibiotics after therapeutic response.