Debridement is most important step in reducing infection/ promoting healing
Avoid betadine/chlorhexadine in wound
Not necessary to remove hair as this can increase chances of infection (if do, avoid using razor)
Can use antibiotic ointment to help keep hair out of the way
Can use antibiotic ointment to help keep hair out of the way
High pressure irrigation is best (can be achieved with 18 gauge syringe)
Tap water is as effective as sterile water/ normal saline
Pressure from tap is ~45 psi, higher than syringe
Irrigation optional for face/scalp wound as long as:
Not a bite wound
Not a contaminated wound
Not older than 6 hours
Often best to avoid irrigation of face and opt for cleaning with gauze to help prevent tissue distortion
Pressure from tap is ~45 psi, higher than syringe
Not a bite wound
Not a contaminated wound
Not older than 6 hours
Often best to avoid irrigation of face and opt for cleaning with gauze to help prevent tissue distortion
Often best to avoid irrigation of face and opt for cleaning with gauze to help prevent tissue distortion
Can be topical or injected.
Topical
LET for open wound, EMLA for intact skin
EMLA needs to be left on 1-2 hours 
LET onset is 20-30 minutes, area will appear pale
Evaluate motor/sensation before giving local anesthesia
To decrease pain of injection:
Buffer lidocaine with bicarbonate (1mL bicarb:9mL lidocaine)
Inject slowly
Consider nerve blocks to avoid tissue distortion for cosmetic areas such as vermillion border
Also helpful for extremities, sole of foot
Digital block for finger<unk> s
LET for open wound, EMLA for intact skin
EMLA needs to be left on 1-2 hours 
LET onset is 20-30 minutes, area will appear pale
EMLA needs to be left on 1-2 hours 
LET onset is 20-30 minutes, area will appear pale
Buffer lidocaine with bicarbonate (1mL bicarb:9mL lidocaine)
Inject slowly
Also helpful for extremities, sole of foot
Digital block for finger<unk> s
1% soln contains 10 mg/ml
2% soln contains 20 mg/ml
0.5% soln contains 5 mg/ml
May cause cardiac arrest if injected intravascularly
Do not buffer with bicarbonate
See Soft tissue foreign body
Explore to base of wound
Ideally done in bloodless field
Look for foreign bodies, tendon injury, or fracture
Possible glass or metal in wound = get XR or US to evaluate
See Sutures
If<unk>  not closed immediately secondary to age of wound:
Irrigate and explore wound, then pack with non-adherent or vaseline gauze
Re-check in 3 days - may suture at that point if wound appears clean.
Irrigate and explore wound, then pack with non-adherent or vaseline gauze
Re-check in 3 days - may suture at that point if wound appears clean.
Note: consider use of Fast Absorbing Gut (5-0/6-0) on Ear, Eyelid, Eyebrow, Nose, Lip and Face if anticipated difficulty with suture removal
Note: Favor absorbable sutures for facial<unk>  especially in children
Just as good a suturing according to this  and other articles. Picture on how to do it property from the same article  which is under CC BY-NC-SA 4.0 license:
Useful for areas of low tension and well approximated wounds
Apply 3 layers allowing 30 seconds for first layer to dry
Avoid in bite wounds, contaminated wounds, puncture wounds, mucosal surfaces, areas of high moisture (groin, axilla)
Avoid antibiotic ointments which can prematurely dissolve glue
If you accidentally glue the eyes shut use dexamethasone, neomycin, polymyxin B eyedrops (brand name Maxitrol in the U.S.) on the glue then gentle rubbing after 45 or 90 seconds 
Scalp<unk>  can be done with staples or if the patient has enough hair with Hair Apposition Technique by twisting hair together and using dermabond.
Can bleed a lot, consider figure of 8 stitch to help with hemostasis
Often accompanied by hematomas which may require evacuation for proper skin alignment
Consider antibiotics for
Wounds contaminated by debris or feces
Caused by punctures or bites
Tissue destruction or in avascular areas
Neglected wounds
Wounds contaminated by debris or feces
Caused by punctures or bites
Tissue destruction or in avascular areas
Neglected wounds
Wounds contaminated by fresh water and plantar puncture wounds through athletic shoes should include Pseudomonas coverage
Splinting
Wounds over flexor surfaces or tension
Tetanus prophylaxis
Tdap 0.5cc IM to patients >7y with no booster within 5 yr
Hypertet 250 u IM at diff site from Tdap if NO history of Td or < 3 doses given
Require follow up Tdap at 1mo & 1 yr; age>60 = high risk of poor immunization
Dressing
Keep moist, not wet
Bandaid, xeroform, or ointment
Wound check
48-72 hrs ONLY if high risk wound
No point in checking before 48hr (takes this long for infection to occur)
Wounds over flexor surfaces or tension
Tdap 0.5cc IM to patients >7y with no booster within 5 yr
Hypertet 250 u IM at diff site from Tdap if NO history of Td or < 3 doses given
Require follow up Tdap at 1mo & 1 yr; age>60 = high risk of poor immunization
Require follow up Tdap at 1mo & 1 yr; age>60 = high risk of poor immunization
Keep moist, not wet
Bandaid, xeroform, or ointment
Bandaid, xeroform, or ointment
48-72 hrs ONLY if high risk wound
No point in checking before 48hr (takes this long for infection to occur)
No point in checking before 48hr (takes this long for infection to occur)
Preventing infection
Keep wound clean and covered
Apply antibiotic ointment twice daily
Once healed, encourage daily sunscreen use and Vitamin E creams
Keep wound clean and covered
Apply antibiotic ointment twice daily
Signs of neurovascular or tendon injury
Facial wounds that cross cosmetic boundaries
Tissue loss
Laceration repair
Burn dressings
Negative pressure wound therapy
Pressure immobilization dressing
Escharotomy
Improvised wound management
Finger amputation
Hair tourniquet