Step 1: History and physical examination

Each wound that is encountered must be addressed independently. Factors such as location, size, mechanism of injury, time elapsed since injury, likelihood of contamination and patient dependent factors must be addressed prior to formal treatment.

Mechanism of injury: provides insight into potential injury to adjacent structures, likelihood of contamination and preferred method of repair. Laceration resulting from blunt force often require debridement and revision of wound edges to optimize healing.

Time elapsed from injury to repair: any wound that has been exposed for greater than 8 hours is at significant risk for infection, regardless of the mechanism of injury. Grossly contaminated wounds such as animal bites and farm injuries are at such great risk for infection that they are best left open.

Patient dependent factors: includes advanced age, poor nutritional status and coexisting illnesses such as diabetes which can lead to delayed healing, abnormal scarring and infection and must be considered when instructing the patient regarding follow-up.

A functional assessment of nerves, blood vessels, muscles and tendons is essential and must be done prior to injection of local anesthesia as this will obviously interfere with the assessment.

As with all medical care, it is imprtant to be aware of one's own abilities and limitations and to request assistance if necessary.