Minor incised traumatic lacerationBMJ 2012; 345 doi: http://dx.doi.org/10.1136/bmj.e6824 (Published 23 October 2012) Cite this as: BMJ 2012;345:e6824
- Jochen W L Cals, general practitioner and assistant professor,
- Eefje G P M de Bont, trainee general practitioner and research student
- 1Department of General Practice, CAPHRI School for Public Health and Primary Care, Maastricht University, P O Box 616, 6200 MD Maastricht, Netherlands
- Correspondence to: J Cals
- Accepted 28 September 2012
A 40 year old man consults with a minor laceration of the left arm. He cut himself with a knife while working in the garden. He has washed the wound and the bleeding has stopped.
What you should cover
Minor incised traumatic lacerations often happen during daily household activities, while working, and while doing sports and hobbies.
Explore the mechanism of injury and consider the possibility of contamination of involved surfaces or instruments. Ask about the time of the laceration and about subsequent cleansing and disinfecting.
Explore risk factors for potentially compromised wound healing, such as diabetes mellitus, use of immunosuppressive medication, peripheral vascular disease, bleeding diathesis, and history of keloid formation or scar hypertrophy.
Ask the patient’s preference for method of wound closure. Most lacerations can be managed in primary care; closing methods include transcutaneous or intracutaneous sutures, adhesive (cyanoacrylate) glue, or adhesive plasters.
Inform the patient about risk of infection, pain during the procedure, and scarring. Obtain and record informed consent.
What you should do
Physical examination and wound cleansing
Inspect thoroughly the size, edges, and depth of the wound, particularly focusing on damage to the underlying and surrounding tissue, the vitality of the wound, and contamination. Check motor and sensory function distal to the wound, as well as circulation (pulses, capillary refill). Assess for tendon damage by checking movement and range of motion, especially for lacerations on extremities. Localised sharp pain when a wound is palpated is a useful indicator of a possible foreign body.
Refer the patient to a surgeon if you diagnose or suspect musculotendinous injury; if the wound is more likely …