MKSAP Quiz: evaluation for a laceration on the leg
An 80-year-old woman is evaluated for a laceration on her leg. On the previous day, she hit the corner of her bed, tearing the skin. She would like recommendations regarding wound care. Medical history is remarkable for polymyalgia rheumatica for which she takes prednisone daily. Following a physical exam, what is the most appropriate treatment?
An 80-year-old woman is evaluated for a laceration on her leg. On the previous day, she hit the corner of her bed, tearing the skin. She would like recommendations regarding wound care. Medical history is remarkable for polymyalgia rheumatica for which she takes prednisone daily.
On physical examination, the patient has a 2-cm superficial laceration on her right anterior shin. The surrounding skin is purpuric and notably thinned. No surrounding erythema is seen. The patient's tetanus immunization status is up to date.
Which of the following is the most appropriate treatment?
A. Apply a hydrocolloid dressing
B. Apply a nonadherent dressing over plain petrolatum
C. Apply a nonadherent dressing over triple-antibiotic ointment
D. Leave the wound open to air
MKSAP Answer and Critique
The correct answer is B: Apply a nonadherent dressing over plain petrolatum. This item is available to MKSAP 16 subscribers as item 69 in the Dermatology section. More information is available online.
Although there are many commercially available dressings that would be appropriate to use for treatment of this laceration, a simple, cost-effective dressing is a nonadherent dressing over plain petrolatum. This patient has atrophic skin, so use of adherent dressings and tape should be avoided to minimize the risk of unintended damage to surrounding skin. The dressing can be held in place with an elastic bandage, by gauze, or by a self-adherent elastic bandage.
A variety of newer generation wound dressings is available, including transparent adherent film dressings, hydrocolloid, hydrogel, calcium alginate, and foam dressings. Their use has improved the management of complex wounds, including venous and pressure ulcers; however, they are more expensive and are not usually necessary for the management of uncomplicated, simple wounds.
Routine use of topical antibiotics to treat clean wounds is not recommended, as there is a risk of allergic contact dermatitis, particularly from bacitracin and neomycin. Additionally, antibacterial resistance to topical antibiotics is a growing problem.
Allowing the wound to remain uncovered and dry is not recommended, as formation of a dry eschar prolongs the time of wound healing and may result in more discomfort than with an occlusive dressing.
Key Point
- A simple, cost-effective dressing for superficial wounds is a nonadherent dressing over plain petrolatum.