Urgent Care · Common Complaints
Minor Wounds / Skin Infections
Most wounds and skin infections seen in urgent care are routine. The trap is missing necrotizing infection, deep abscess, retained foreign body, or tendon/nerve injury under what looks like a simple laceration. This page covers the can't-miss diagnoses (necrotizing fasciitis, deep space abscess, occult tendon/nerve/vascular injury, retained foreign body, septic joint, open fracture, animal/human bite over a joint), red flags including pain out of proportion, crepitus, dusky skin, bullae, rapidly spreading erythema, the minimum safe first-pass workup with structured wound exploration and neurovascular exam, suturing vs referral decisions, abscess I&D technique, antibiotic selection for cellulitis (purulent vs non-purulent, MRSA risk), escalation criteria, documentation, tetanus prophylaxis, and return precautions. Written for NPs, PAs, and MDs in outpatient practice.
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Urgent Care · Common Complaints
Minor Wounds / Skin Infections
Why this symptom matters
Most are routine. The trap is missing necrotizing infection, deep abscess, retained foreign body, or tendon/nerve injury under what looks like a simple laceration.
What must I not miss first?
- Necrotizing fasciitis
- Deep space abscess (hand, perirectal, retropharyngeal)
- Tendon, nerve, vascular injury under a "simple" laceration
- Retained foreign body
- Septic joint
- Open fracture
- Animal/human bite over joint or tendon
Red flags — escalate or work up urgently
- Pain out of proportion, crepitus, dusky skin, bullae, rapidly spreading erythema
- Fever, hypotension, tachycardia, AMS
- Immunocompromise, IV drug use, diabetic with foot wound
- Loss of motor or sensory function distal to injury
- Wound over joint with effusion or limited ROM
- Cat bite or human bite over hand
- Anticoagulated with significant bleeding
Immediate Management — While You Work It Up
- Irrigate wounds copiously with normal saline — before any closure decision. Irrigation is the single most important step in wound care.
- Cephalexin 500 mg QID × 5–7 days — non-purulent cellulitis without systemic symptoms.
- TMP-SMX 1–2 DS tabs BID × 5–7 days — purulent infection or abscess, MRSA coverage.
- Clindamycin 300–450 mg TID — alternative if sulfa allergy or TMP-SMX contraindicated.
- Tetanus assessment — ask about last tetanus booster. Give Td or Tdap if > 5 years for dirty wounds or > 10 years for clean wounds. Document.
- Do not close wounds with signs of active infection — irrigate, pack open, and recheck in 48 hours.
- Epinephrine with lidocaine is safe for digital blocks — the old teaching about digits is outdated. Use standard 1% lidocaine with epinephrine for hemostasis.
Minimum safe first-pass workup
- What to ask: mechanism (clean vs. dirty, sharp vs. crush), time since injury, tetanus status, allergies, immunocompromise, medications (anticoagulants), occupation/hand dominance
- What to examine: distal neurovascular exam BEFORE anesthesia, motor/sensory testing, tendon function, foreign body palpation, depth and undermining, lymphangitis
- X-ray for any glass, metal, or suspected fracture/foreign body
- Mark cellulitis margins; reassess in 24 hours
- Wound culture only if abscess drained, immunocompromised, or failed prior abx
What can usually be managed outpatient
- Clean lacerations within closure window with intact distal exam
- Simple abscesses ≤ 5 cm: I&D, packing only if cavity, no routine antibiotics in immunocompetent
- Uncomplicated cellulitis without sepsis criteria, drawn margins, oral abx, 24-hour reassessment
- Tetanus update as indicated
When to escalate to ED / higher level of care
- Any necrotizing infection clue
- Sepsis criteria, hemodynamic instability
- Hand/face/perirectal/deep-space abscess
- Wound with neurovascular or tendon injury, suspected foreign body that can't be removed
- Bite to the hand, especially cat or human
- Diabetic foot ulcer with deep infection or osteomyelitis concern
- Anticoagulated with uncontrolled bleeding
What to document when the diagnosis is still uncertain
- Mechanism, time since injury, tetanus status
- Distal NV exam BEFORE anesthesia — motor, sensation, capillary refill
- Wound description, depth, foreign body assessment, X-ray result if obtained
- "Necrotizing infection / deep abscess / tendon-nerve injury / retained FB considered because…"
- Closure technique, suture material/size, antibiotic choice, follow-up timing
Safety-net & return precautions to give
- Return or call 911 for spreading redness, fever, severe pain, drainage of pus, numbness, inability to move the part, or red streaks running up the limb.
- Keep wound clean and dry per instructions; suture removal in [X days].
- Follow up in 24–48 hours for wound check; sooner if any red flags.
Educational guidance for clinicians. Not a substitute for clinical judgment. Always individualize to the patient and your local resources.
Evidence sources
- · IDSA SSTI Guidelines 2014
- · ACEP Clinical Policies
Review status
Last reviewed: 2026-04
Reviewed by the MyClinicianGuide editorial team. Cadence: annual.
Educational reference for licensed clinicians (NP, PA, MD, DO). Not a substitute for clinical judgment, institutional protocols, or specialty consultation. Apply in context of the full clinical picture, patient goals, and current standards of care. See About AI guidance for AI-related limitations.
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