Laceration Repair

Laceration Repair

 

Definition

A laceration is a wound caused by a sharp object producing edges that may be jagged, dirty, or bleeding. Lacerations most often affect the skin, but any tissue may be lacerated, including subcutaneous fat, tendon, muscle, or bone.

Purpose

A laceration should be repaired if it:
  • Continues to bleed after application of pressure for ten to fifteen minutes
  • Is more than one-eighth to one-fourth inch deep
  • Exposes fat, muscle, tendon, or bone
  • Causes a change in function surrounding the area of the laceration
  • Is dirty or has visible debris in it
  • Is located in an area where an unsightly scar is undesirable.

Precautions

Lacerations are less likely to become infected if they are repaired soon after they occur. Many physicians will not repair a laceration that is more than eight hours old because the risk of infection is too great.

Description

Laceration repair mends a tear in the skin or other tissue. The procedure is similar to repairing a tear in clothing. Primary care physicians, emergency room physicians, and surgeons usually repair lacerations. The four goals of laceration repair are to stop bleeding, prevent infection, preserve function, and restore appearance. Insurance companies do pay for the procedure. Cost depends upon the severity and size of the laceration.
Before repairing the laceration, the physician thoroughly examines the wound and the underlying tendons or nerves. If nerves or tendons have been injured, a surgeon may be needed to complete the repair. The laceration is cleaned by removing any foreign material or debris. Removing foreign objects from penetrating wounds can sometimes cause bleeding, so this type of wound must be cleaned very carefully. The wound is then irrigated with saline solution and a disinfectant. The disinfecting agent may be mild soap or a commercial preparation. An antibacterial agent may be applied.
Once the wound has been cleansed, the physician anesthetizes the area of the repair by injecting a local anesthetic. The physician may trim edges that are jagged or extremely uneven. Tissue that is too damaged to heal must be removed (debridement) to prevent infection. If the laceration is deep, several absorbable stitches (sutures) are placed in the tissue under the skin to help bring the tissue layers together. Suturing also helps eliminate any pockets where tissue fluid or blood can accumulate. The skin wound is closed with sutures. Suture material used on the surface of a wound is usually non-absorbable and will have to be removed later. A light dressing or an adhesive bandage is applied for 24-48 hours. In areas where a dressing is not feasible, an antibiotic ointment can be applied. If the laceration is the result of a human or
A laceration is a traumatic break in the skin caused by a sharp object producing edges that may be jagged, dirty, or bleeding. The underlying tissue may also be severed. In such instances, the physician may place absorbable sutures in the tissue to help bring the edges together before the skin is sutured close.
A laceration is a traumatic break in the skin caused by a sharp object producing edges that may be jagged, dirty, or bleeding. The underlying tissue may also be severed. In such instances, the physician may place absorbable sutures in the tissue to help bring the edges together before the skin is sutured close.
(Illustration by Electronic Illustrators Group.)
animal bite, if it is very dirty, or if the patient has a medical condition that alters wound healing, oral antibiotics may be prescribed.

Aftercare

The laceration is kept clean and dry for at least 24 hours after the repair. Light bathing is generally permitted after 24 hours if the wound is not soaked. The physician will provide directions for any special wound care. Sutures are removed 3-14 days after the repair is completed. Timing of suture removal depends on the location of the laceration and physician preference.
The repair should be observed frequently for signs of infection, which include redness, swelling, tenderness, drainage from the wound, red streaks in the skin surrounding the repair, chills, or fever. If any of these occur, the physician should be contacted immediately.

Key terms

Debridement — The act of removing any foreign material and damaged or contaminated tissue from a wound to expose surrounding healthy tissue.

Risks

The most common complication of any laceration repair is infection. Risk of infection can be minimized by cleansing the wound thoroughly. Wounds from bites or dirty objects or wounds that have a large amount of dirt in them are most likely to become infected.
All lacerations will heal with a scar. Wounds that are repaired with sutures are less likely to develop scars that are unsightly, but no one can predict how wounds will heal and who will develop unsightly scars. Plastic surgery can improve the appearance of many scars.

Resources

Other

"Caring for Cuts and Scrapes at Home." Mayo Clinic Online. 〈http://www.mayohealth.org/mayo/9611/htm/cuts_sb.htm〉.
"Laceration Repair." ThriveOnline. http://thriveonline.oxygen.com.
References in periodicals archive ?
24, 2015 /PRNewswire/ -- The safety of children could be at risk when they undergo common procedures involving sedation, such as for fracture reduction, laceration repair, and incision and drainage of an abscess.
They included fine-needle aspiration, incision and drainage of abscesses and cysts, removal of cysts, wick placement, laceration repair, treatment of soft-tissue injuries, biopsies and repair, excisional and brush biopsies, release of lingual frenulum, treatment of mucoceles, endoscopy, flexible laryngoscopy, videostroboscopy, drug therapy, uvulectomy, treatment of dysphagia and reflux, foreign body removal, myringoplasty, micro-otoscopy and photo documentation, mastoid cleansing, postoperative care, intertympanic steroid injection, Epley maneuver, polypectomy, epistaxis control, repair of deviated nasal septum, coblation under local anesthesia, closed reduction of nasal fractures, and many more.
Typical procedures performed under PSA in the ED or minor theatre setting are reduction of fractures and common dislocations, incision and drainage of abscesses, laceration repair in children, foreign body removal, and evacuation of retained products of conception (RPOC).
Risk factors for the breakdown of perineal laceration repair after delivery [Electronic version].
There are no data supporting the use of prophylactic antibiotic treatment before or after laceration repair, but because of the 25% infection rate associated with the secondary repair, Dr.
JETTY[R] is indicated for use during episiotomy and vaginal laceration repair to temporarily prevent the postpartum discharge of fluids from the vagina in order to assist with the repair procedure.
The CLEAR-TRAC family of retractors includes: CLEAR-TRAC SP, a single-use surgical pocket retractor designed for procedures requiring illumination and exposure during surgical dissection; CLEAR-TRAC V, a single-use vaginal retractor perfect for vaginal laceration repair and other operative gynecological procedures; and CLEAR-TRAC B, a single-use breast retractor ideal for breast augmentation, reconstruction, and mastectomy and lumpectomy procedures.
The Equine Seminar will cover a variety of topics including equine head ultrasound-guided aids, equine head radiography, equine sinus trephining, ocular pain management, soft tissue laceration repair of the head, dental procedures and more.
Routine uses include minor laceration repair, dermatologic and gynecologic exams, as well as oral and nasal exams.
Over the study period, patients received propofol for orthopedic reduction (72%), lumbar puncture (10%), laceration repair (17%) and ocular examination (1%).
jetty(TM) is indicated for use during episiotomy and vaginal laceration repair to temporarily prevent the postpartum discharge of fluids from the vagina in order to assist with the repair procedure.
Demographics and initial injury (a) Onset of Age Injury and initial ulnar nerve Case (yr)/sex treatment Level symptoms 1 4/M Right closed Type III Distal humerus 1 mo supracondylar fracture K-wire and casting 2 9/F Left closed proximal Proximal forearm Immediate radius/ulnar fracture Casting 3 9/M Left full-thickness Proximal forearm Immediate laceration Laceration repair (a) M, male; F, female; K, kirschner.