With all lacerations, injury to the local vasculature must always be considered to prevent significant sequelae The evaluation for vascular injury should start with a complete evaluation of pulses Depending on the wound location, this might include the femoral, popliteal, dorsalis pedis, posterior tibial, axillary, radial, and ulnar pulses When evaluating for the presence and quality of pulses, it is important to compare the injured side to the noninjured side for asymmetry Signs of arterial injury include hemorrhage, hematoma, bruit over the wound, absent distal pulses, and signs of ischemia (pallor, pain, coolness) If there is concern for vascular injury, a surgical consultation should take place The next step in evaluation may direct exploration in the operating room or imaging such as an arteriograph or CT angiogram LACERATIONS IN PROXIMITY TO JOINTS CLINICAL PEARLS AND PITFALLS Keep a high index of suspicion of possible joint cavity violation when evaluating large wounds in close proximity to large joints such as the knee, elbow, and ankle Orthopedic consultation is required when there is concern for joint violation Fluid seepage or “sucking” sound during clinical examination should raise concern immediately Use 3-0 nonabsorbable sutures for noncommunicating lacerations over large joints and consider splinting the extremity to avoid wound dehiscence Lacerations that occur near joints need special consideration (see Chapters 42 Injury: Knee and 111 Musculoskeletal Trauma ) These most commonly include lacerations near the knee, elbow, or ankle With even minor lacerations, there is risk for developing septic arthritis if there is joint involvement Indications that the laceration may extend into the joint include fluid seepage, sucking wound sound, palpable effusion, painful range of motion, and palpable capsular defect with probing If it is difficult to assess the penetration of the wound by clinical examination, radiographs may be helpful Concerning signs on x-ray may include a joint effusion, foreign body near or in the joint, or air in the joint space If there is clinical suspicion for joint involvement, orthopedic consultation is advised to