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the splash guard just above the skin surface, the clinician should apply firm
pressure to the plunger. This technique is usually capable of generating 5 to 8
lb/psi which is considered ideal pressure for wound irrigation. Some institutions
may have splash guards that attach directly to the bottle of saline. Consider
warming the saline before irrigation because this may be more comfortable. Tap
water is equally effective at irrigating wounds without increasing risk for
infection. Soaking the injured body part should be avoided because this may lead
to maceration of the wound and edema.
Scrubbing the wound should be reserved for particularly “dirty” wounds in
which contaminants are not effectively removed with irrigation alone. Use topical
or infiltrative anesthetics for pain control before scrubbing. It may be necessary to
extract some foreign material with fine forceps if it remains adherent after
copious irrigation. This will avoid tattooing of the skin and reduce the risk of
infection.
In rare cases, the wound must be extended with a scalpel to allow proper
exploration and cleaning. The provider should consider trimming small amounts
of tissue in irregular lacerations and excising necrotic skin but should not make
dramatic changes in the wound. Devitalized tissue should be removed only if it
looks ischemic or is otherwise clearly indicated. If more extensive debridement is
deemed necessary, consultation with a surgical specialist is recommended.
Subcutaneous fat can be safely and easily removed if it interferes with wound
closure. It is wise to remove such fat carefully, in small quantities, to avoid
disruption of small vessels and cutaneous nerve branches. Avoid removal of facial
fat because this may leave an unsightly depression. Debridement is advantageous
because it creates well-defined wound edges that can be more easily opposed.
However, excessive removal of tissue can create a defect that is difficult to close
or may increase tension at the wound margin such that scarring is more likely.
Examine the wound further after cleansing and debridement. After exploration,
it is wise to reevaluate the decision to close the wound primarily. When
proceeding further, emergency providers should wash their hands before donning
gloves. Sterile gloves are still commonly utilized, although some studies report no

increased risk of infection with nonsterile gloves. Sterile masks do not reduce the
risk of wound infections, but a facial splash shield is useful to protect the
clinician. The area surrounding the wound should be appropriately draped before
wound repair. However, if a young child is particularly upset by facial drapes,
they can be omitted. Proper cleaning of the wound is more important to
uncomplicated healing than meticulous attempts to avoid introduction of small
numbers of bacteria by preserving a sterile field.