A 21-year-old male bitten on the forearm by a dog has a large avulsion with a peeled-back flap. In addition to bleeding control, you should:

• A. Irrigate the wound for at least 15 minutes.
• B. Perform a rapid head-to-toe assessment.
• C. Replace the avulsed flap to its original position.
• D. Apply oxygen via a nonrebreathing mask.

Answer: (C)

Replacing the avulsed flap to its original position is the best next step after stopping the bleed because the tissue remains viable if its blood supply is preserved. Repositioning the flap realigns the tissue so that vessels can continue to perfuse it, minimizes tissue loss, and improves healing and appearance. Handle the flap gently, avoid tearing, and place it back exactly where it came from. Once realigned, cover with a clean, sterile, moist dressing and immobilize the area to protect the tissue. After that, proceed with wound irrigation and further assessment as part of ongoing care, but the crucial action to optimize outcome is reapproximation of the flap.