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Lacerations & wound care
Close it right, check tetanus, and know which wounds aren’t yours.
Typical consult⏱ 25–30 min
Investigations🔬 X-ray only for glass / foreign body
Usual outcome💊 Closure + tetanus + wound advice
0–5Red flags + history5–12Examine12–17Decide17–24Treat + explain24–30Safety-net + document
1Rule out first — red flags
| If you find… | …then |
|---|---|
| Tendon, nerve or vascular injury | Hand / plastic surgeons |
| Wound over a joint, or bite into a joint | Possible joint penetration — ortho / hand surgery |
| Full-thickness lip vermilion border, eyelid margin, ear cartilage | Plastics / maxfax / ophthalmology |
| Heavily contaminated, crush or > 6 h old (non-face) | Consider delayed closure |
| Suspected glass or foreign body | X-ray and explore |
2Focused history
3Focused examination
4Decide — investigate only if it changes the plan
Choosing the closure
- Tissue glue: small, clean, low-tension wounds (avoid near eyes, hair, joints)
- Steri-strips: superficial straight wounds, thin skin (elderly pretibial)
- Sutures: deeper or gaping wounds, high-tension areas, hands
- Scalp: sutures/staples, or hair apposition for small wounds
Irrigate thoroughly with saline / tap water first. Lidocaine 1% up to 3 mg/kg (max 200 mg) for infiltration.
| Investigation | Only if… |
|---|---|
| X-ray | Glass or metal foreign body suspected |
5Treat & send home
Management & advice
- Irrigate well; remove debris
- Close with glue / strips / sutures as above
- Tetanus: give a booster if not fully immunised (5 doses) or unknown; tetanus-prone wounds in the incompletely immunised may also need human tetanus immunoglobulin (UKHSA Green Book table)
- Keep dry for 48 h, then gentle washing
- Suture removal: face 3–5 days, scalp 7–10, trunk 7–10, limbs 10–14, over joints/hands 10–14
Refer / follow-up
- Tendon / nerve / joint / complex facial wounds → plastics / hand / maxfax
- Pretibial flap lacerations in the elderly → per local pathway (often nurse-led dressing clinic)
℞
Discharge prescription (TTO)Typical adult doses — check the BNF/BNFc, allergies, renal function, pregnancy and interactions.
| Drug | Dose | Duration / notes |
|---|---|---|
| Paracetamol | 1 g every 4–6 hours, max 4 g in 24 h (reduce if under 50 kg or liver risk) | As needed |
| Antibiotics | Not routinely needed for clean wounds | Consider for heavily contaminated wounds or bites — see the bites page |
6Safety-net
Say it like this
I’ve cleaned and closed the cut. Keep it dry for 2 days, then you can wash it gently. The stitches need to come out in about [X] days at your GP practice nurse. Come back if it becomes red, hot, swollen, starts oozing pus, or you feel feverish.
Come back / call 111 — or 999 if severe — if:
- Increasing redness, heat, swelling, pus or red streaks
- Fever or feeling unwell
- Numbness or weakness beyond the wound
- Wound opens up
7Patient leaflets — scan & go
Official NHS pages. Ask the patient to scan the code with their phone camera, or tap “Show to patient” to make it full screen.
8Document
Lacerations & wound care — clinic note
A structure to document efficiently. It is not a completeness check — use your trust’s system and your clinical judgement.
URGENT CARE — LACERATIONS & WOUND CARE
PRESENTING COMPLAINT:
HISTORY
Mechanism, object, time of injury:
Contamination (soil, glass, bite):
Hand dominance, job:
Tetanus immunisation history:
PMH: diabetes, immunosuppression, anticoagulants; allergies (incl. lidocaine, plasters):
RED FLAGS (record present / absent)
[ ] Tendon, nerve or vascular injury
[ ] Wound over a joint, or bite into a joint
[ ] Full-thickness lip vermilion border, eyelid margin, ear cartilage
[ ] Heavily contaminated, crush or > 6 h old (non-face)
[ ] Suspected glass or foreign body
PMH:
DRUG HISTORY:
ALLERGIES:
SOCIAL (job / who is at home / driving):
OBSERVATIONS: RR SpO2 HR BP Temp (NEWS2 )
EXAMINATION
Site, length, depth, edges, contamination:
Distal neurovascular status before anaesthetic:
Tendon function against resistance:
Explore under good light after anaesthetic and irrigation:
DECISION RULE — Choosing the closure: result ______
INVESTIGATIONS: none required / X-ray — result:
IMPRESSION:
PLAN
Treatment / TTO (drug, dose, duration):
Advice given:
Leaflet given (QR / printed): Cuts and grazes
Follow-up / referral:
SAFETY-NETTING (told to return / call 111 / 999 if):
- Increasing redness, heat, swelling, pus or red streaks
- Fever or feeling unwell
- Numbness or weakness beyond the wound
- Wound opens up
Patient understands and agrees with the plan: Y / N
Seen by: Grade: Date/Time:
✓Guidelines
Doses are typical adult doses drawn from the guidance above. Always check the current BNF/BNFc and your local antimicrobial policy.
More wounds, burns & skin
Minor burns & scaldsCool, cover, size it — and know when it goes to the burns unit.Human & animal bitesWho gets prophylaxis, rabies risk and the fight bite.Insect bites, stings & tick bitesBig local reactions vs infection vs anaphylaxis — and Lyme.CellulitisOral antibiotics at home or IV? Mark the edges and safety-net.