Management of lacerated wounds

First Line

Second Line

Specialist

Hospital Only

Invasive Group A Streptococcal infections have increased in incidence and need to be assessed rapidly in hospital. Maintain a high index of suspicion in patients with a high fever, severe muscle aches, confusion, unexplained D&V, local muscle tenderness, or severe pain out of proportion to external signs, hypotension, a flat red rash over large area of the body, conjunctival suffusion.

Thorough irrigation is recommended. Drinkable tap water, boiled and cooled water, and normal saline are all comparable wound cleansing agents. Assess risk of tetanus.

Antibiotic therapy is usually not indicated unless:

Crushed and deep punctures
Wounds to the hands, face or genitals
Immunocompromised
Cirrhotic, asplenic, or hyposplenic

In these cases prompt irrigation and co-amoxiclav 625mg every 8 hours for 5 days.

If symptoms and signs of infection develop after closure of the laceration:

If previously contaminated - co-amoxiclav 625mg every 8 hours for 5 days
If not previously contaminated – flucloxacillin 500mg every 6 hours for 7 days

Formulary

Management of lacerated wounds