Physical Examination

Wound examination is greatly facilitated by a calm and cooperative patient, appropriate positioning, adequate lighting, and, sometimes, magnification. 11 Sterile technique would seem to be important, but studies using clean, but nonsterile, gloves found no increase in the incidence of wound infections. However, it is important to practice universal precautions and protect the patient and physician from cross infection.

Several factors should be noted and documented during wound examination (Xable..35:3). Areas with excellent vascular supply and a low incidence of infection include the scalp, face, neck, and trunk. Lacerations on the extremities are at increased risk for infection, and those on the feet and hands are at greatest risk. Lacerations on the hands can damage tendons, nerves, and joints important for normal function. Lacerations over joints may penetrate into the joint capsule and are at risk for hypertrophic scar formation. Any laceration over the metacarpophalangeal joint is suspicious for a clenched-fist injury. Lacerations in the perineum have a high likelihood for contamination.

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