FIGURE 110.1 A seemingly superficial laceration at the wrist might be treated simply by closure of the subcutaneous tissue and skin, unless one appreciates the abnormal posture of a finger when the hand is at rest The loss of normal flexor tone as a result of a divided superficial tendon results in the involved finger lying in a position of relative extension Patients found to have vascular, nerve, or tendon injury or deep, extensive wounds to the face warrant consultation with a surgical specialist for possible repair in the operating room Management Decision to Close the Wound Most wounds may be closed primarily, meaning the wound edges are approximated as soon as possible after the injury to speed healing and improve the cosmetic result If primary closure is delayed, the risk of subsequent infection increases Some authors suggest that the “golden period” for wound closure is hours However, wounds at low risk for infection (e.g., a clean kitchen knife injury) can be closed even 12 to 24 hours after the injury Most wounds of the face are best closed primarily, even up to 24 hours after injury to achieve an optimal cosmetic effect If the wound is extensive or has a high potential for infection (e.g., a dog bite), thorough irrigation is essential, and in cases of extensive or complex wounds, the operating room may be the best site for this repair Conversely, wounds at high risk for infection such as those in