Soft-tissue wounds to the hand are common. These injuries vary from simple, clean, sharp superficial lacerations to deep, severely contaminated crush injuries. Use of the terms lacerations or open wounds implies that the skin barrier has been violated. Bacterial contamination, with superficial and deep soft-tissue damage, may have occurred. Optimal treatment of these injuries requires obtaining an adequate history along with a systematic physical evaluation of the extremity. The history should include general information concerning the patient (e.g., age, hand dominance, comorbid medical conditions, tetanus status) in addition to information about the injury itself. Socioeconomic factors (e.g., work injuries, self-inflicted injuries) may also play a role in the treatment of these injuries.

The initial treatment of these injuries should include using sterile, compressive dressings and elevation of the hand to control bleeding if present. The use of hemostats, placed into the wound to control bleeding, should be avoided. A careful assessment of the entire extremity and not only the injured area should be performed.

In general, wounds that are over 6 hours old should not be closed. Open treatment or healing by secondary intention is very useful for infected hand wounds and chronic open wounds (Table 1). Simple, clean wounds may be débrided, irrigated, and closed. Heavily contaminated wounds also should be débrided, irrigated, packed, and left open. Débridement of damaged and contaminated tissues is important in proper wound management. Irrigation of the wound should be performed using a pulsating jet lavage irrigation system.

Antibiotic coverage may not be needed in the treatment of simple, clean wounds. Wounds with a higher risk of infection (e.g., human or animal bites, penetrating wounds, crush wounds, or contaminated wounds) should have antibiotic coverage. These wounds should also have aerobic and anaerobic cultures taken at the time of débridement. In general, a first-generation cephalosporin (e.g., Ancef, Kefzol) or penicillinase-resistant penicillin (e.g., Nafcillin, Oxacillin, Methicillin) can be used (Table 2).

The most common pathogens for human bites include Staphylococcus aureus, Streptococcus, Eikenella corrodens, and Bacteroides B. Antibiotic coverage includes Penicillin G and Cefazolin, Timentin, Unasyn, or Augmentin (Amoxicillin plus K-clavulanate). Animal bites should be covered for Pasturella multocida
in addition to S. aureus and Streptococcus, and should have antibiotic coverage similar to human bites.