A 36-year-old man comes to the office due to a leg injury. He suffered an abrasion to his right leg after falling from his motorcycle 5 days earlier. The patient washed the wound with tap water and covered it with an occlusive dressing but is now having increasing pain. He has not removed the dressing for the last 3 days due to pain. Past medical history is unremarkable. On examination, he is afebrile but has a 10-cm abrasion on the lateral right leg involving the epidermis and superficial dermis. There is a surrounding area of erythema and warmth extending 3-5 cm from the margin of the wound.
Which of the following is the most appropriate next step in management of this patient?

Question

A 36-year-old man comes to the office due to a leg injury.  He suffered an abrasion to his right leg after falling from his motorcycle 5 days earlier.  The patient washed the wound with tap water and covered it with an occlusive dressing but is now having increasing pain.  He has not removed the dressing for the last 3 days due to pain.  Past medical history is unremarkable.  On examination, he is afebrile but has a 10-cm abrasion on the lateral right leg involving the epidermis and superficial dermis.  There is a surrounding area of erythema and warmth extending 3-5 cm from the margin of the wound.
Which of the following is the most appropriate next step in management of this patient?

Quizplus · Accepted Answer

This patient has a large abrasion with signs of associated moderate cellulitis. In addition to erythema and purulence, clinical features suggesting infection include increasing pain, swelling, fever, lymphangitis, and regional adenopathy. Mild superficial infections (eg, impetigo) in immunocompetent patients may be treated with topical mupirocin (Choice D). However, more extensive cellulitis (>2 cm from the wound margin) or infection of deep tissues should be treated with systemic antibiotics. impetigo deep tissues Patients with moderate cellulitis may be managed with oral antibiotics that have good coverage for Staphylococcus and Streptococcus species. Cellulitis without pustules or purulent exudate may be treated with clindamycin, dicloxacillin, or cephalexin. However, purulence suggests infection with methicillin-resistant S aureus, and antibiotics other than cephalosporins are recommended. First-choice antibiotics include clindamycin or trimethoprim/sulfamethoxazole. Moderate infection associated with bite wounds should receive antibiotics with anaerobic coverage (eg, amoxicillin/clavulanate). Immunocompromised patients or those with severe wound infections (eg, high fever, hemodynamic instability) will require hospitalization for intravenous antibiotics (Choice A). cellulitis bite wounds (Choice C) Hydrogen peroxide may be considered in initial wound management to remove dried blood and necrotic debris, but it is ineffective in treating established wound infections and does not promote healing. (Choice E) Wet-to-dry and wet-to-moist gauze dressings are frequently used to aid debridement in wounds with extensive exudate. However, gauze dressings are labor-intensive and do not reliably maintain a moist wound environment. Educational objective: Mild superficial wound infections in immunocompetent patients may be treated with topical mupirocin. More extensive cellulitis (>2 cm from the wound margin) or infection of deep tissues should be treated with systemic antibiotics. __________ References: Common questions about wound care. (http://www.ncbi.nlm.nih.gov/pubmed/25591209)

A 36-Year-Old Man Comes to the Office Due to a Leg