Treatment of a simple wound — MSF Clinical guidelines — Médecins Sans Frontières 2026

Q: When can a simple wound be sutured immediately?

Immediate suturing is appropriate only for clean, simple wounds less than 6 hours old with no devitalised or contused tissue. Wounds on the face, scalp, upper limbs or hands may be sutured up to 24 hours after injury. Wounds must first undergo proper cleaning, exploration and excision.

Q: Which wounds should never be sutured immediately?

Bites (animal or human) and bullet, shell or mine shrapnel wounds should never be immediately sutured. These require cleaning, exploration, excision and either delayed suturing after 72 hours if no infection develops, or healing by secondary intention.

Q: What is the proper sequence for treating a simple wound?

The order is: initial cleaning with soap or 7.5% povidone iodine scrub and water, exploration after disinfecting with 10% povidone iodine and administering local anaesthetic (1% lidocaine without epinephrine), then excision of devitalised tissue, followed by immediate or delayed suturing based on wound characteristics.

Q: When should delayed suturing be performed?

For wounds that do not meet criteria for immediate suturing (contaminated, more than 6 hours old, or with devitalised tissue), apply a simple dressing and perform daily cleaning and removal of necrotic tissue. If after 72 hours there are no signs of local infection, the wound may then be sutured.

MSFClinical guideline (chapter)Current edition

From Clinical guidelines — Diagnosis and treatment manual › Chapter 10: Medical and minor surgical procedures · Médecins Sans Frontières, Current online edition, 2026

MSF clinical guideline for management of simple wounds by clinicians in resource-limited settings.

In one sentenceImmediately suture only clean simple wounds <6 hours old (24 hours for face/scalp/upper limbs); never suture bites or shrapnel wounds; delay suturing contaminated/old wounds 72 hours if no infection develops.

Issuer: Médecins Sans Frontières
Edition: Current online edition, 2026
Audience: Clinicians managing wounds in primary care and emergency settings
Evidence: Expert consensus based on MSF field experience
Reviewed: 21 Oct 2026 · GMJ

Read the original on MSF Whole guideline (PDF)

Summary by GMJ Guidelines Desk•Reviewed by Prof. Giorgi Pkhakadze, MD, MPH, PhD•Record updated 21 Oct 2026•Next check Apr 2027

What this guideline says

GMJ summary

This section from the MSF Clinical Guidelines provides practical guidance on managing simple wounds—defined as breaks in skin continuity limited to subcutaneous fatty tissue without affecting underlying structures (muscle, bone, joints, major arteries, nerves, tendons) or significant tissue loss. The guideline emphasises rapid treatment following the sequence of cleaning-exploration-excision while maintaining asepsis.

The central decision framework distinguishes between immediate suturing (for clean wounds less than 6 hours old, or up to 24 hours for face, scalp, upper limbs or hands), delayed suturing after 72 hours (for contaminated or older wounds showing no infection), and healing by secondary intention (for infected wounds). Bites and bullet/shrapnel wounds should never be immediately sutured. The guideline stresses infection prevention including tetanus prophylaxis and appropriate use of local anaesthesia with 1% lidocaine without epinephrine.

Detailed technical instruction covers required equipment (basic surgical instrument sets), step-by-step technique including initial cleaning with soap or 7.5% povidone iodine scrub, exploration under local anaesthesia, judicious excision of devitalised tissue, and suturing methods with illustrated figures demonstrating proper instrument handling and knot-tying techniques.

Key points

For clinicians — doses and thresholds as stated in the guideline

Simple wounds are breaks in skin limited to subcutaneous tissue, not affecting underlying structures (muscle, bone, joints, major arteries, nerves, tendons)
Immediate suturing permitted only for clean, simple wounds less than 6 hours old (or up to 24 hours for face, scalp, upper limbs, hands)
Never immediately suture bites or bullet/shell/mine shrapnel wounds
Use 1% lidocaine without epinephrine for local anaesthesia, waiting at least 2 minutes for effect
Clean wounds with soap or 7.5% povidone iodine scrub solution, then disinfect with 10% povidone iodine
Delayed suturing after 72 hours permitted if no signs of local infection develop
Administer systemic antibiotics at least 1 hour prior to care if patient has general signs of infection (fever, chills, altered condition)
Excise devitalised tissue generously but limit skin excision, particularly on face

From the guideline

Verbatim

“immediately suture recent, clean, simple wounds (less than 6 hours old) and delay suturing contaminated wounds and/or those more than 6 hours old”

— Médecins Sans Frontières, Treatment of a simple wound — MSF Clinical guidelines, Treatment goals section (2026)

Editor’s perspective

Why this matters for Georgia and the region

Prof. Giorgi Pkhakadze, MD, MPH, PhD

Editor-in-Chief, Georgian Medical Journal · Chair, Public Health Institute of Georgia · WHO consultant, health and migration

As Editor-in-Chief of the Georgian Medical Journal and Chair of the Public Health Institute, I recognise that wound management remains a fundamental skill in Georgian primary care and emergency departments, yet practice patterns often lack the standardisation this MSF guideline provides. The clear time-based criteria—6 hours for most wounds, 24 hours for facial and upper limb wounds, and the 72-hour delayed suturing protocol—offer Georgian clinicians an evidence-based framework that can reduce wound infections and improve healing outcomes. I would particularly stress to our colleagues the absolute contraindication to immediate suturing of bite wounds and shrapnel injuries, as premature closure of these contaminated wounds risks serious complications including anaerobic infections. The main implementation challenge in Georgia will be ensuring that rural ambulatories and district hospitals maintain properly sterilised instrument sets and have reliable access to appropriate suture materials and local anaesthetics, which requires strengthening our medical supply chains beyond the capital.

ORCID 0000-0001-7609-4515 · Perspective written for the GMJ Guidelines Library, 21 Oct 2026

Applicability

Georgia and the South Caucasus

This guideline is highly relevant for Georgia and the South Caucasus region, particularly in rural and resource-limited primary care settings where minor surgical procedures are commonly performed by general practitioners and emergency physicians. Georgian national protocols should ensure that primary healthcare facilities are equipped with basic surgical instrument sets and that clinicians are trained in the critical distinction between wounds requiring immediate versus delayed suturing. The emphasis on infection prevention aligns with Georgia’s ongoing efforts to strengthen antimicrobial stewardship and reduce healthcare-associated infections. National programmes should consider incorporating the clear time-based criteria (6 hours, 24 hours for specific sites, 72 hours for delayed closure) into standardised treatment algorithms for emergency departments and ambulatory surgical units across the country.

Questions this guideline answers

Quick answers

When can a simple wound be sutured immediately?

Immediate suturing is appropriate only for clean, simple wounds less than 6 hours old with no devitalised or contused tissue. Wounds on the face, scalp, upper limbs or hands may be sutured up to 24 hours after injury. Wounds must first undergo proper cleaning, exploration and excision.

Which wounds should never be sutured immediately?

Bites (animal or human) and bullet, shell or mine shrapnel wounds should never be immediately sutured. These require cleaning, exploration, excision and either delayed suturing after 72 hours if no infection develops, or healing by secondary intention.

What is the proper sequence for treating a simple wound?

The order is: initial cleaning with soap or 7.5% povidone iodine scrub and water, exploration after disinfecting with 10% povidone iodine and administering local anaesthetic (1% lidocaine without epinephrine), then excision of devitalised tissue, followed by immediate or delayed suturing based on wound characteristics.

When should delayed suturing be performed?

For wounds that do not meet criteria for immediate suturing (contaminated, more than 6 hours old, or with devitalised tissue), apply a simple dressing and perform daily cleaning and removal of necrotic tissue. If after 72 hours there are no signs of local infection, the wound may then be sutured.

Related on GMJ

Interconnected resources

Dictionary of Public Health

Complex wounds to the head

GMJ News coverage

Quality & accreditation

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Dressings — MSF Clinical guidelinesChapter 10: Medical and minor surgical procedures
Abnormal uterine bleeding (in the absence of pregnancy) — MSF Clinical guidelinesChapter 9: Genito-urinary diseases
Major genital infections (summary) — Clinical guidelines — Diagnosis and treatment manual — MSF Clinical guidelinesChapter 9: Genito-urinary diseases
Venereal warts — MSF Clinical guidelinesChapter 9: Genito-urinary diseases
Upper genital tract infections (UGTI) — MSF Clinical guidelinesChapter 9: Genito-urinary diseases
Genital ulcers — MSF Clinical guidelinesChapter 9: Genito-urinary diseases

Treatment of a simple wound — MSF Clinical guidelines

What this guideline says

Key points

From the guideline