anatomic locations with poor blood supply, contaminated or crush wounds, and those involving immunocompromised hosts should be closed promptly, within hours of injury Some contaminated wounds (e.g., animal or human bites or those occurring on a farm) in an immunocompromised host should not be sutured, even if the patient presents immediately for care Some wounds should be allowed to heal by secondary intention (secondary closure), although scar formation may be more unsatisfactory Infected wounds, ulcers, and many animal bites are best left to heal by granulation and reepithelialization Human bites over the metacarpophalangeal joints (clenched-fist bites) are especially prone to infection and risk infection with primary closure Puncture wounds to the foot, with only a small laceration and a low concern for cosmetic results, may also be left open A small sterile wick of iodoform gauze may be placed inside the wound to keep the edges open This gauze can be removed after to days, and the subsequent granulation tissue will aid healing TABLE 110.2 WOUND ASSESSMENT—GENERAL PRINCIPLES Primary survey—control bleeding Secondary survey—other injury? History Mechanism Age of wound—time of injury Possible foreign body Environment Health status—tetanus immunization Physical examination Location Muscle function Tendon involvement Vascular injury Nerve injury Foreign material Laboratory Consider radiographs or ultrasound if a foreign body or fracture is suspected