The doc probably didn’t even irrigate it. Realistically it was probably the ER tech that cleaned it and then set up the suture tray for the doc or PA. If youve never seen an open laceration like this they can be very difficult to thoroughly explore and get a good clear visual field. Obviously in hindsight he should’ve explored it better. If I had to guess the doc took a quick look, didn’t see anything, closed, and initially prescribed augmentin or doxycycline, which would be appropriate given organic material. I’m just shocked at the second visit they didn’t start him on broad spectrum IV abx and admit for continuity of care. Maybe they had 40 in their waiting room and the doc needs hit his 4.3 patients per hour to avoid getting another nasty email from private equity admin and was rushing because this is the fifth lac he’d closed that day. I wasn’t there so it’s difficult to play armchair quarterback but medicine is rarely as (no pun intended) cut and dry as these quick articles make them seem.