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.