The Forearm and Wrist

Any patient with a laceration to the wrist or forearm must be questioned about suicide. If the laceration is the result of a suicide attempt or gesture, the patient should be placed in a secure environment with adequate supervision.

The function of all tendons and neurovascular structures, especially the abductor pollicis longus and extensor pollicis brevis functions, should be checked in lacerations of the radial aspect of the distal forearm. Most of these wounds can be closed with simple 4-0 nonabsorbable interrupted sutures (nylon or polypropylene). If the wound is gaping or under high tension, absorbable deep buried sutures or nonabsorbable horizontal mattress suture are recommended. The multiple parallel lacerations that are classic for a suicide attempt often preclude closure with simple interrupted sutures, and the horizontal mattress suture method, running through all lacerations with one suture is ideal (Fig 40-4). The depth of this suture should be uniform throughout the entire stitch. This reduces wound tension, prevents ischemia, and approximates the edges with fewer sutures.

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