[Durgical](https://durgical.com/en/) › [DurgiPedia](https://durgical.com/en/durgipedia/) › [Clinical skills](https://durgical.com/en/clinical-skills/) › [Wounds and sutures](https://durgical.com/en/clinical-skills/areas/wounds/) › Assessing a wound: close it now, later or never?

# Assessing a wound: close it now, later or never?

- Procedure

Before stitching, the doctor checks how and when the cut happened, how dirty it is and what lies beneath, then decides to close it now or let it heal open.

Updated Nov 13, 2026

## Key points

- Check and record distal neurovascular status and tendon function before injecting local anaesthetic.
- There is no fixed «golden period»: clean wounds are often closed within about 12–18 hours and facial wounds up to about 24 hours.
- Heavily contaminated, infected or old wounds and most puncture and cat or hand bites are left open or closed late.
- Glass and metal show on a plain radiograph; wood and plastic often do not, and ultrasound may find them.
- Healing phases: haemostasis, inflammation, proliferation, remodelling; a mature scar never regains full skin strength.

On this page

- The basics Key points
- What it is
- Indications
- Equipment
- Step by step (and why)
- Next step
- Elsewhere in DurgiPedia

- Clinical Complications

- Safety Contraindications and precautions

- Study Test yourself

- Connections Connections

## What it is

Every laceration is assessed before anything is closed. The history gives the mechanism (sharp cut, crush, bite, glass, high-pressure injection), the time since injury, the likely contamination, tetanus status and anything that slows healing (diabetes, steroids, smoking, poor circulation, malnutrition). The examination looks at site, length, depth, edges and tissue loss, and checks distal pulses, capillary refill, sensation and every tendon's function before any anaesthetic is given. The wound is then explored in a good light, in a bloodless field, through its full range of motion, for foreign bodies and injured deep structures. Three paths follow: primary closure (stitches, staples, strips or adhesive now) for clean, recent wounds; delayed primary closure after a few days of open care for contaminated wounds; or healing by secondary intention for wounds that are heavily contaminated, old, infected or small and in places where the scar does not matter. Healing then passes through haemostasis, inflammation, proliferation and a long remodelling phase, which is why a scar keeps changing for months.

## Indications

- Primary closure: clean, recent wounds with healthy edges that can be brought together without tension.
- Delayed primary closure: contaminated wounds cleaned, packed and closed after a few days once free of infection.
- Secondary intention: heavily contaminated, infected or late wounds, abscess cavities, and small wounds where the scar matters little.
- Wounds on the face and scalp heal well because of their blood supply and are more often closed even when presenting late.
- Referral to a surgeon: tendon, nerve or vessel injury, joint or bone involvement, eyelid margin, lip vermilion, cartilage or major tissue loss.

## Contraindications and precautions

- Do not close a wound with signs of infection, retained foreign body or devitalised tissue that has not been removed.
- Closure under tension causes ischaemia of the edges, dehiscence and a wide scar; undermine, use another technique or refer.
- High-pressure injection injuries of the hand look small but need urgent surgical review.
- Patients with diabetes, peripheral vascular disease, steroid use or immunosuppression heal slowly and get infected more often.
- Non-accidental injury, self-harm or assault should be considered and documented when the story does not fit the wound.

## Equipment

- Good light, gloves, eye protection and a sterile dressing pack.
- Irrigation set: large syringe with a splash shield or a fine cannula, and sterile saline or clean drinkable tap water.
- Local anaesthetic set: fine needles, syringe and the agent chosen within its maximum safe dose by weight.
- Instruments: toothed forceps, needle holder, scissors, and a skin hook or small retractor for exploration.
- Closure material ready to choose from: sutures, staples, adhesive strips or tissue adhesive, and a dressing.

## Step by step (and why)

- Take the history: mechanism, time, place, contamination and tetanus status — these decide the risk of infection and whether to close.
- Ask about diabetes, steroids, smoking, anticoagulants and allergies — they change healing, bleeding and the choice of anaesthetic.
- Examine pulses, refill, sensation and each tendon against resistance — injuries hidden by anaesthesia are missed later.
- Order a radiograph for glass, metal or a crush near bone — retained fragments cause infection and pain.
- Anaesthetise, then irrigate and explore the whole depth through the range of motion — a tendon cut in flexion hides in extension.
- Remove foreign material and trim devitalised tissue — dead tissue feeds bacteria and prevents healing.
- Decide: primary, delayed primary or secondary intention — based on age of the wound, contamination, site and tension.
- Close with the least reactive method that holds the edges, and evert them — everted edges flatten into a neat scar.
- Dress, give tetanus prophylaxis if needed and explain warning signs — infection and dehiscence are the main early failures.

## Complications

- Wound infection: redness spreading from the edges, warmth, pain, pus or fever; remove some stitches, drain and review.
- Dehiscence: the wound reopens, usually from tension, infection or early removal of stitches.
- Missed injury: a tendon, nerve or foreign body found late because exploration was incomplete.
- Poor scars: widened, hypertrophic or keloid scars, worse on the chest, shoulders and in darker skin.
- Stitch marks («railroad tracks») when sutures are tied too tight or left in too long.

## Next step

- Refer the same day if a tendon, nerve, vessel, joint, eyelid margin, lip vermilion or cartilage is involved.
- Check tetanus status for every wound and act on it before discharge.
- Give written aftercare: keep dry for the first day or two, then gentle washing, and when and where stitches come out.
- Plan review in about 48 hours for contaminated wounds or those left open for delayed closure.
- Return at once for spreading redness, pus, fever, increasing pain, numbness or a wound that reopens.

## Test yourself

Think of the answer, then tap the question to see it.

## Why must neurovascular status and tendon function be tested before injecting local anaesthetic?

The anaesthetic removes sensation and can mask weakness, so a nerve or tendon injury would be missed; record the findings first.

## Which three ways can a wound be managed after assessment?

Primary closure now, delayed primary closure after a few days of open care, or healing by secondary intention.

## Which foreign bodies are usually visible on a plain radiograph and which may need ultrasound?

Glass and metal are usually visible on a radiograph; wood, plastic and other organic material often are not and may be found with ultrasound.

## What are the four phases of wound healing in order?

Haemostasis, inflammation, proliferation (granulation, new vessels, epithelium) and remodelling (maturation), which lasts many months.

[Add to my cards (4)](https://durgical.app/estudiar/?add=/en/clinical-skills/assessing-a-wound-close-it-now-later-or-never/)

## Elsewhere in DurgiPedia

- [Healing of skin wounds: first and second intention](https://durgical.com/en/general-pathology/healing-of-skin-wounds-first-and-second-intention/)
- [Wound healing: phases and scar](https://durgical.com/en/histology/wound-healing-phases-and-scar/)
- [Lacerations: blunt-force tears of the skin](https://durgical.com/en/forensic-medicine/lacerations-blunt-force-tears-of-the-skin/)
- [Wound assessment: bed, edges, exudate and signs of infection](https://durgical.com/en/nursing/wound-assessment-bed-edges-exudate-and-signs-of-infection/)

## Connections

## Related 7

- [Cleaning and irrigating a wound before closure](https://durgical.com/en/clinical-skills/cleaning-and-irrigating-a-wound-before-closure/)
- [Infiltrating local anaesthetic and digital blocks](https://durgical.com/en/clinical-skills/infiltrating-local-anaesthetic-and-digital-blocks/)
- [Suture materials and needles: absorbable or not, sizes and choice](https://durgical.com/en/clinical-skills/suture-materials-and-needles-absorbable-or-not-sizes-and-choice/)
- [The simple interrupted stitch](https://durgical.com/en/clinical-skills/the-simple-interrupted-stitch/)
- [Staples, adhesive strips and tissue adhesive](https://durgical.com/en/clinical-skills/staples-adhesive-strips-and-tissue-adhesive/)
- [Animal and human bites: clean, close or leave open](https://durgical.com/en/clinical-skills/animal-and-human-bites-clean-close-or-leave-open/)
- [Tetanus prophylaxis after a wound: who needs what](https://durgical.com/en/clinical-skills/tetanus-prophylaxis-after-a-wound-who-needs-what/)

## Related conditions 4

- [Flexor tendon injury](https://durgical.com/en/conditions/flexor-tendon-injury/)
- [Surgical site infection](https://durgical.com/en/conditions/surgical-site-infection/)
- [Wound dehiscence and evisceration](https://durgical.com/en/conditions/wound-dehiscence-and-evisceration/)
- [Keloid and hypertrophic scar](https://durgical.com/en/conditions/keloid-and-hypertrophic-scar/)

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Educational content; it does not replace supervised hands-on training, your institution's protocols or a prescriber's order. A procedure is learnt with a teacher and done only once you are trained to do it.

Sources: [Wound Closure Techniques](https://www.ncbi.nlm.nih.gov/books/NBK470598/) (StatPearls (NCBI Bookshelf), 2023); [Wound Healing Phases](https://www.ncbi.nlm.nih.gov/books/NBK470443/) (StatPearls (NCBI Bookshelf), 2023).

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Representative model, for educational purposes only.

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Source: https://durgical.com/en/clinical-skills/assessing-a-wound-close-it-now-later-or-never/
License: CC BY 4.0 (https://creativecommons.org/licenses/by/4.0/). Cite as: DurgiPedia (durgical.com), https://durgical.com/en/clinical-skills/assessing-a-wound-close-it-now-later-or-never/