Thoroughly irrigate wound withnormal saline. Take extreme care to avoid injury to nerves or blood vessels. Cauterization should be avoided to prevent such damage. If bleeding cannot be controlled using general pressure and elevation, referral to a hand surgeon is appropriate. If a hand surgeon is too far away for primary repair, cleanse and close the wound and splint the hand, then refer as soon as possible for delayed primary tendon repair.
Antibiotic coverage is indicated.
Splint with fingers and wrist in safe position when possible. Alternative positioning may be necessary to protect tendon or nerve repair. Dressing should not apply pressure. Hematoma is prevented by thesurgeon, not by the use of a tight dressing. Edema is controlled by elevation, not by pressure.