Laceration assessment in general practice: close, leave or refer?

History

• Mechanism — cut, crush, bite or high-pressure injury
• Time since injury
• Tetanus status, medications and anticoagulants
• Diabetes, immunosuppression, smoking

Examination

• Check distal sensation, movement and circulation before local anaesthetic
• Test tendon function against resistance
• Explore for foreign bodies; consider imaging for glass
• Note depth, length, tension and contamination

Red flags for referral

• Tendon, nerve or major vessel injury
• Wounds involving the eyelid margin, lip vermilion border or ear cartilage
• Animal or human bites to the hand
• Heavily contaminated or crush wounds
• Significant tissue loss or wounds you can't close without tension

Common questions

Can a GP stitch a cut?

Yes. Most simple lacerations can be assessed, cleaned and sutured in general practice by a trained clinician. Complex wounds should be referred.

How long after injury can a wound be stitched?

Many clean wounds can be closed within several hours, and facial wounds often later because of their good blood supply. Contaminated or older wounds may be better left open or delayed. Follow local guidance.