Disposition

Patients with hard signs of arterial injury are not a diagnostic dilemma. These patients require surgical intervention or, at the very least, expedient surgical evaluation and angiography. Patients with soft signs of arterial injury require inpatient observation. Patients with penetrating extremity injury, no signs of arterial injury, no bony or nervous injury, minimal soft tissue defect, and no signs of developing compartment syndrome can be safely discharged home with close follow-up after a period of observation and serial examinations. There is no consensus on the ideal observation time, but the current literature describes times from 3 to 12 h. Wound exploration in the emergency department should be reserved for those patients with suspected foreign bodies in the wound, for ligamentous involvement, or for control of minor venous bleeding. Wound exploration to control arterial or major venous bleeding should be done in the operating room. The general principles of wound management, including tetanus prophylaxis, apply here. Although controversial, there is no proven role for prophylactic antibiotics unless a wound is contaminated or patients have an underlying preexisting condition that would predispose them to infection.

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