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.
Gale Encyclopedia of Medicine. Copyright 2008 The Gale Group, Inc. All rights reserved.
References in periodicals archive ?
Patients included in each study underwent outpatient cutaneous or mucosal surgical procedures, including laceration repair, standard excisions, Mohs micrographic surgery, or tooth extractions.
MUC specializes in women's health, immunizations for children six months and older, allergy relief, and suture and laceration repair.
Supraorbital nerve block along with local infiltration of anaesthetic was effective and sufficient to perform eyelid laceration repair without any difficulties.
(17) In a study of 144 cases of wound breakdown following a perineal laceration repair, the major risk factors for wound breakdown were episiotomy (aOR, 11.1), smoking (aOR, 6.4), midwife repair of laceration (aOR, 4.7), use of chromic suture (aOR, 3.9), and operative vaginal delivery (aOR, 3.4).
Objective: The objective of this study was to compare 5/0 polypropylene suture with 5/0 chromic catgut in small clean pediatric facial laceration repair in terms of cosmetic outcome.
(15), 1997, Laceration repair prospective (52.4) observational for Fracture reduction ETC[O.sub.2], randomized (28.6) controlled for drugs Dental procedures (14.3) Incision, and drainage of an abscess (4.7) Tobias (16), 1999, Painful, invazive prospective procedures (it is not observational case series clear in the study) McQuillen and Steele (17), Fracture reduction 2000, (55) prospective Laceration repair (37) observational case series Incision, and drainage of an abscess (4) Lumbar puncture (4) Langhan et al.
Does the use of topical lidocaine, epinephrine, and tetracaine solution provide sufficient anesthesia for laceration repair? Acad Emerg Med.
Even paediatric emergency fast track clinics and paediatric triage are considered as another source to deal and managing non-acute paediatric emergencies conserving the precious time of management.9 Similarly paediatric fractures/dislocations, procedures and laceration repair can be managed early with the introduction of the procedural sedation and preventing the resource and time and hence are able to discharge the child home early and reduce emergency congestion.
Bruns TB et al in their study of 61 children have concluded that, the use of Histoacryl Blue (HAB) tissue adhesive for laceration repair is an acceptable alternative to conventional suturing with a comparable cosmetic outcome.
The aim of this study was to evaluate the results of flexor tendon laceration repair in zone 5 treated with early motion of the digits after surgery.
Three months posttraumatic corneal laceration repair, cataract extraction, and posterior chamber intraocular lens (IOL) implantation, IOL subluxation were reported (Figure 12).