Laboratory studies are not indicated during the initial evaluation of an uncomplicated wound. If the wound becomes infected, a complete blood cell count may assist in determining the degree of cellulitis and the effectiveness of antibiotic therapy. Obviously, the most important parameter to monitor is the clinical appearance of the infection. Some clinicians also follow an erythrocyte sedimentation rate. Blood cultures and a wound culture are obtained if bacteremia is anticipated in immunocompromised patients. A wound culture of the laceration site immediately obtained in the ED for an open fracture or a grossly contaminated wound may be useful.
Radiographic imaging is required when an open fracture is suspected. The ideal form of radiographic imaging for foreign-body detection is debated. In cases of inert materials, standard plain-film radiographs and adequate wound exploration suffice. On the radiograph, the wound site is indicated with a radiodense marker. Though the retained material may be radiographically "invisible," there can be distortion of soft tissue shadows indicating the foreign body. When retained organic material is highly suspected, computed tomography is required. Retained foreign bodies can be visualized on ultrasound, although experience using this modality on the foot is limited.
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