Acute wound management in the emergency department (ED) focuses on two primary goals: avoiding infection and achieving a functional, cosmetically acceptable scar. Effective management requires a deep understanding of the physiological phases of wound healing—hemostasis, inflammation, proliferation, and maturation. Practitioners must distinguish between wounds suitable for primary closure and those requiring secondary or delayed primary closure based on wound age, mechanism of injury, and patient-risk factors.
Critical takeaways for the experienced practitioner include:
- Healing Dynamics: Wounds typically regain 80% of their original tensile strength by six weeks, though full maturation can take up to 180 days.
- The "Golden Period": Most clean, simple lacerations can be closed up to 12–18 hours after injury, with head/neck wounds extending to 24 hours due to high vascularity.
- Preparation is Paramount: Irrigation remains the most effective method for decreasing infection. Pressures of 5–8 PSI are ideal for most minor wounds.
- Suture Selection: Use the thinnest suture feasible (e.g., 6-0 for face, 4-0/5-0 for extremities). Deep dermal sutures should utilize absorbable materials like Polyglactin 910 to reduce surface tension.
