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Provider Prepared’s Weekly Pearl of Wound Wisdom #20 Getting on my nerves!

Provider Prepared’s Weekly Pearl of Wound Wisdom #20 Getting on my nerves! 0

A 23 year old male presents to the emergency department, with extensive laceration to his left forearm from a motorcycle accident. In addition to the pain of the laceration, he feels numb in his little finger, with tingling in his ring finger, and tingling in a part of the palm of his left hand.

Sensory and motor functions of the hand arise from innervation by the median, radius and ulnar nerves. Examination of the hand should always include checking motor function as well as pin prick, light touch and two-point discrimination. Normal two-point discrimination will increase with age and neuropathic disease, but is considered approximately 4-5 mm.
Bassett, RE et al. Finger and thumb anatomy. UpToDate, July 2016.

On examination of this patient’s left hand, he is found to have decreased sensation in the 5th digit, ulnar aspect of the 4th digit and weakness with extension of the digits and wrist. This raises the concern for injury to the ulnar nerve associated with the forearm laceration.

Visit Provider Prepared for honest, accurate and affordable wound care at home and on the go!

Provider Prepared
Nathan Whittaker, MD
  • Brandon Durfee
Provider Prepared’s Weekly Pearl of Wound Wisdom #19 Thumbs up!

Provider Prepared’s Weekly Pearl of Wound Wisdom #19 Thumbs up! 0

A 27 year old female presents to the Emergency Department for management of a laceration to her left hand. While cutting an avocado, she accidentally cut her left hand using the knife to remove the pit. The laceration is at the base of the thumb, extending into deep tissue.


Proper examination of hand wounds requires an understanding of hand anatomy and function. During assessment of the wound, function and sensation of the digits must be evaluated. The thumb requires special attention for proper examination. The thumb is made up of two phalanges, in comparison to the other digits which have three. The thumb has more movement capabilities than the other fingers. At the carpometacarpal joint the thumb can flex, extend, abduct, adduct, oppose, and retropulse. The metocarpophalangeal joint allows the thumb to flex, extend, abduct, and adduct. The interphalangeal joint provides for flexion and extension.
Bassett, RE et al. Finger and thumb anatomy. UpToDate, July 2016.


Evaluation to ensure all these thumb movements are intact must be part of thumb wound evaluation.


This patient has all movements of her left them intact with good strength, sensation is intact as well. On exploration of the wound there is no evidence of any deep structure injury. The laceration was closed with a single layer repair without complication. A thumb spica splint was then placed to immobilize the thumb, promoting less tension on the wound.


Visit Provider Prepared to see our options for all your home laceration care needs!


Provider Prepared
Nathan Whittaker, MD

  • Brandon Durfee
Provider Prepared’s Weekly Pearl of Wound Wisdom #18 Dehisced

Provider Prepared’s Weekly Pearl of Wound Wisdom #18 Dehisced 0

Occasionally, despite careful layered closure of any wound, wound dehiscence can occur. Reasons for dehiscence include: high tension in the wound, atrophic skin, lack of patient compliance with wound care instructions, medications that inhibit wound healing, poor circulation, lack of deep absorbable sutures, wound infection.
Wounds that dehisce typically should heal by secondary intention. The wound should have a thin layer of petrolatum, or as appropriate antibiotic ointment, applied with a nonadherent dressing. The dressing should be changed daily.
Ritchie, SI et al. Skin surgery: Prevention and treatment of complications UpToDate, December 2017.


Dehisced wounds should be carefully examined for infection. With any signs of infection topical and systemic antibiotic treatment should be used as clinically appropriate.


Be prepared for wound care at home and on the go with tools of the trade from Provider Prepared!


Provider Prepared
Nathan Whittaker, MD

  • Brandon Durfee
Provider Prepared’s Weekly Pearl of Wound Wisdom #17 So it begins!

Provider Prepared’s Weekly Pearl of Wound Wisdom #17 So it begins! 0

The skin healing process occurs in several stages, outlined as: coagulation, epthelialization, new blood vessel growth, collagen formation and wound contraction.

Coagulation begins immediately with vasospasm and platelet aggregation. This allows for fibrous clot formation to occur.
The epidermis is the layer capable of regeneration. This is where epithelialization occurs, leading to bridging of the wound tissues.

Four days into wound healing, new blood vessel growth is at its peak. 48 hours after the injury collagen formation begins, and peaks in the first week. Collagen gives tensile strength to the tissues. The process of collagen formation and remodeling can continue for 12 months.

Three to four days after the injury, wound contraction occurs. This process is not well understood or well described in literature. The full thickness of the wound migrates toward the center, this can have impact in the final appearance of the wound.
deLemos, DA, et al. Closure of minor skin wounds with sutures. UpToDate Nov. 2016

Start the healing process right with a laceration repair kit from Provider Prepared!

Provider Prepared
Nathan Whittaker, MD
  • Brandon Durfee
Provider Prepared’s Weekly Pearl of Wound Wisdom #16 Leg vs Tiller!

Provider Prepared’s Weekly Pearl of Wound Wisdom #16 Leg vs Tiller! 0

A 72 year old male with diabetes presents to the Emergency Department for management of a lower leg wound. The large, complex laceration was created about 30 hours prior while rototilling his garden. The rototiller skipped off of a rock causing the tiller tines to impact his lower leg. The wound was heavily contaminated with dirt that he rinsed out in a shower last night.

Delayed primary closure is the type of closure that should be used for wounds that are older than 24 hours that have had extensive contamination and were insufficiently cleansed. Additionally, wounds older than 24 hours associated with diabetes, advanced age, smoking, renal impairment, poor nutrition, obesity, and chronic steroid therapy should have delayed primary closure considered as their means of management.
Brancato, JO et al. Minor wound preparation and irrigation. UpToDate December 2017.

This 72 year old patient had his wound thoroughly cleansed and dressed in a sterile fashion. He was started on 10 days of cephalexin and five days later returned for wound closure. The wound margins were debrided and then closed with horizontal mattress sutures. 14 days later, sutures were removed from a well healed wound with no complications.

Provider Prepared has all your wound care needs available now! Visit us for the peace of mind and integrity of being prepared at home and on the go.

Provider Prepared
Nathan Whittaker, MD

  • Brandon Durfee
Provider Prepared’s Weekly Pearl of Wound Wisdom #15 This happened how long ago?

Provider Prepared’s Weekly Pearl of Wound Wisdom #15 This happened how long ago? 0

Making the decision to perform primary closure, healing by secondary intention, or delayed primary closure is primarily based upon clinical judgment. Absolute contraindications to wound closure are redness, warmth, swelling, and excessive pain. In the absence of these findings, wound closure is appropriate.

Wounds that are generally appropriate for healing by secondary intention are: deep stabbing puncture wounds that cannot be adequately irrigated, heavily contaminated wounds that cannot be appropriately cleaned, small noncosmetic animal bites, abscess cavities that have undergone incision and drainage. Delay in presentation for wound care is also an indication for secondary intention.

Wounds that are on the trunk or proximal extremity that have been caused by clean, sharp objects can be repaired by primary closure 12 to 18 hours from the time of injury. Similar wounds on the face and neck can be repaired within 24 hours of the injury. For older wounds do not proceed with primary closure.

Brancato, JO et al. Minor wound preparation and irrigation. UpToDate December 2017.

Visit Provider Prepared to get the peace of mind that comes with being prepared for all your wound care needs at home!

Provider Prepared
Nathan Whittaker, MD

  • Brandon Durfee