SOFT-TISSUE INJURIES320 Musculoskeletal and Soft-tissue Emergencies
(iii) Use the smallest practical suture size:
(a) limb laceration: 4/0 synthetic monofilament sutures removed
at 7–10 days
(b) scalp: 2/0 or 3/0 synthetic monofilament sutures removed at 7
days
(c) face: 5/0 or 6/0 synthetic monofilament sutures removed at 4
days.
(iv) Cover the wound with a non-adherent dressing. There is no need
to keep the area dry in the first 24 hours.
(v) Arrange an appointment for removal of the sutures in the ED or
with the general practitioner (GP).
(vi) Make a record in the notes of the size and nature of the wound,
the deep structures involved, and the number of sutures used to
close it.
6 Antibiotics
Do not use antibiotics indiscriminately. They are secondary to thorough sur-
gical toilet in preventing infection, and are best reserved for:
(i) Cellulitis
(a) this is usually due to a -haemolytic Streptococcus or
Staphylococcus aureus if associated with a wound. Send a
swab first
(b) give 1 week of phenoxymethylpenicillin (penicillin V)
500 mg orally q.d.s., or flucloxacillin 500 mg orally q.d.s. if
staphylococcal infection is suspected.
(ii) Dirty, contaminated wound
(a) give flucloxacillin 2 g i.v., gentamicin 5 mg/kg i.v. and
metronidazole 500 mg i.v.
(iii) Bites
(a) clean, debride and irrigate with copious normal saline. Do
not suture, except on the face
(b) give amoxicillin 875 mg and clavulanic acid 125 mg one
tablet orally b.d. for 5 days, unless just a trivial scratch. If
penicillin-allergic, use doxycycline 100 mg once daily orally
and metronidazole 400 mg orally t.d.s. Use roxithromycin if
pregnant or breastfeeding, and in children
(c) give tetanus prophylaxis
(d) consider rabies prophylaxis if the patient was bitten abroad
by a dog, or by a bat in Australia. Discuss this with a local
infectious diseases expert. See page 157.
(iv) Compound fracture
(a) give flucloxacillin 2 g i.v. or cefuroxime 750 mg i.v.
(b) remember tetanus prophylaxis.
7 Tetanus prophylaxis
See below.