Puncture wounds present a clinical dilemma when considering the amount of intervention. Through a logical and thorough history and physical examination a wound score is reached. This scoring system allows for a more objective approach to treatment. Although by no means perfect, wound score will help the clinician in decision making for this difficult clinical problem. Guidelines for the total score are as follows: 1. If the total score is between 1 and 4, treatment is local cleansing and observation. 2. If the total score is between 5 and 8, local cleansing, incision and drainage, and exploration for foreign body is performed with placement of drain. Oral antibiotic regimen is up to local standards of care. 3. If the total score is 9 or more, incision and drainage are mandatory, and wound lavage, intravenous antibiotics, hospitalization, and immobilization are indicated.