Wound Assessment & Laceration Repair
Last Update 1st September 2026
Wound Assessment & Laceration Repair
Acute traumatic wounds in general practice and urgent care. Suture removal timing has its own page.
Assessment
Control bleeding first — direct pressure and elevation. Avoid clamping bleeding vessels blindly, since adjacent nerves are easily damaged. Anaesthetic containing adrenaline also helps reduce bleeding, and a temporary proximal tourniquet can make a bleeding hand or finger wound visible enough to explore.
Test sensation and function before injecting local anaesthetic. Once the field is anaesthetised, a nerve injury can no longer be detected. Check distal sensation, motor function and tendon function against resistance, and document it.
Explore the wound properly, with good light and magnification if needed. Full exploration usually needs anaesthesia — which is why the neurological examination comes first.
Foreign bodies. Glass wounds frequently contain one; wounds from clean sharp metal rarely do. A patient’s own report of feeling something in the wound is not sensitive but is fairly specific, and should never be dismissed. Localised pain, especially pain worse on movement, points the same way. Image if a foreign body is suspected by mechanism, symptom or an unexaminable depth: plain films show glass down to about 1 mm and other inorganic material, but wood and plastic are rarely visible.
Deep structures. Suspect joint penetration in any deep wound near a joint. Never blindly probe a wound over the chest or abdomen — refer for imaging and observation instead.
Healing is impaired by diabetes, immunosuppression, extremes of body mass, poor nutrition, smoking, corticosteroids, anticoagulants and older age, and by wound factors: contamination, drying or maceration, and mechanical stress across the wound.
Cleaning and irrigation
Clip hair with scissors or clippers only if it is in the way — never shave, which causes microtrauma and raises infection risk. Do not trim eyebrows; the hair–skin border is the alignment landmark.
Heavily contaminated wounds are washed first with running tap water and mild soap, before anaesthesia. Potable tap water does not increase infection risk when used this way.
Irrigate with a high-velocity stream — a 20 mL syringe with a 20-gauge needle or IV cannula does the job. Sterile 0.9% saline is an effective irrigant; the expensive surfactant irrigants add little. Continue until visible contamination is gone and at least 100–300 mL has been used, more for large wounds.
Local anaesthesia
See Local Anaesthesia in full. Australian maximum single doses (AMH):
| Agent | Without adrenaline | With adrenaline |
|---|---|---|
| Lidocaine | 3 mg/kg | 7 mg/kg |
| Bupivacaine | 2 mg/kg | 2 mg/kg |
| Ropivacaine | 3 mg/kg | — |
Lidocaine works in 5–10 minutes and lasts 30–60 minutes; bupivacaine is slower in onset and lasts 2–4 hours. Adding adrenaline prolongs the block and gives haemostasis, so it suits the highly vascular face and scalp. The old teaching to avoid adrenaline in fingers, nose, ears and penis is no longer supported — complications are rare and its use in these sites is now considered safe.
Aspirate before injecting an adrenaline-containing solution. Warming the solution and injecting slowly through the wound edges both reduce pain.
Topical LET (lidocaine, adrenaline, tetracaine) on a soaked pledget left in the wound for 30 minutes often anaesthetises a small wound completely, and is the obvious first move in a frightened child.
A regional nerve block distorts the wound edges less than local infiltration, which matters when alignment must be exact — a lip laceration crossing the vermilion border, or any finger wound.
Closure
- Sutures — the standard for primary closure. Non-absorbable for the skin; absorbable deep dermal sutures to take tension off a deeper wound.
- Staples — a reasonable alternative for linear scalp and limb lacerations. Fast, cheap, comparable infection and healing rates. Not for the face.
- Tissue adhesive — best for simple, regular, low-tension lacerations, and excellent in children because there is no removal visit. Not for wounds under tension unless the tension is taken by deep sutures or immobilisation.
- Adhesive strips — useful for low-tension wounds and where a limb is about to be casted.
Suture technique rests on three principles: distribute tension to the deeper layers, handle tissue atraumatically, and evert the wound margins. Line the skin edges up precisely, and do not pull sutures so tight that the edges blanch.
A common error is a cursory exploration and no debridement because a “quick glue job” was planned. Preliminary wound care is identical whatever the closure material.
When not to close
- Bite wounds — human bites and most animal bites are left open.
- Grossly contaminated wounds, or wounds with significant tissue loss.
- Wounds presenting late.
Primary closure suits uninfected, relatively uncontaminated wounds under about 6–8 hours old, and up to 12–24 hours on the face and scalp. There is no hard evidence for a specific cut-off, so judge contamination and blood supply rather than the clock alone.
Delayed primary closure is the answer for a contaminated wound without tissue loss: anaesthetise, explore and debride as thoroughly as for any wound, pack loosely with saline-soaked gauze, change the dressing daily, and close at 3–5 days if there is no infection.
Tetanus
Any wound other than a clean, minor cut is tetanus-prone. Tetanus can follow a trivial injury such as a rose thorn. Higher-risk wounds include compound fractures, bites, deep penetrating wounds, wounds containing foreign bodies (wood splinters especially), wounds with extensive tissue damage, and any superficial wound obviously contaminated with soil, dust or manure. For a compound (open) fracture specifically, see Open Fractures & Contaminated Limb Wounds.
| Vaccination history | Since last dose | Wound | Vaccine | TIG |
|---|---|---|---|---|
| ≥3 doses | <5 years | Clean minor | No | No |
| ≥3 doses | <5 years | All other | No | No* |
| ≥3 doses | 5–10 years | Clean minor | No | No |
| ≥3 doses | 5–10 years | All other | Yes | No* |
| ≥3 doses | >10 years | Clean minor | Yes | No |
| ≥3 doses | >10 years | All other | Yes | No* |
| <3 doses or uncertain | Uncertain | Clean minor | Yes | No |
| <3 doses or uncertain | Uncertain | All other | Yes | Yes |
* Give tetanus immunoglobulin regardless of vaccination timing if the patient has a humoral immune deficiency or HIV.
Tetanus immunoglobulin is given IM as soon as practicable: 250 IU within 24 hours of injury, 500 IU after 24 hours. Antibiotics neither prevent nor treat tetanus. Give dTpa rather than dT if a pertussis dose is also due, including in pregnancy.
Antibiotics
Prophylactic systemic antibiotics are not indicated for most lacerations. The exceptions are bite wounds on the extremities, human bites, wounds involving tendon, bone or joint, some intraoral lacerations, and heavily contaminated wounds. When indicated, give them as early as possible.
Aftercare
Apply a non-adherent dressing impermeable to bacteria, and keep the wound clean and dry. Topical antibiotic ointment daily reduces infection risk and keeps the wound moist — but never over tissue adhesive or adhesive strips.
Immobilise: splint wounds near a joint, use a bulky dressing for fingers and hands, and elevate above heart level for the first 48 hours. Keep a significant lower-limb laceration off the ground for a few days.
Brief showering is safe after 12 hours; prolonged soaking is not.
Infection. Steadily increasing pain 12 or more hours after closure is usually the first sign, followed by erythema extending more than about 0.5 cm from the wound edge, swelling, tenderness and warmth. Fever, purulent discharge and lymphangitis come later. Treat with an antibiotic active against skin flora. Infection starting more than 5–7 days after the injury suggests a retained foreign body — image and re-explore.
Warn the patient that wound tensile strength is only about 30% at three weeks and 80% at three months, and never returns to normal.
Skin tears
Ageing skin loses hair follicles, sebaceous glands, blood supply and sweat glands, becoming thin, brittle and easily injured. Most skin tears come from manual handling — transfers, tape removal, falls, and knocks against bed rails and wheelchair foot plates.
Realign the skin flap if you can, secure it with adhesive skin strips, and cover with a silicone foam dressing. Where the epidermis has been lost, cover the defect with a silicone tulle first. Then address recurrence: a twice-daily moisturiser significantly reduces the incidence of further skin tears.