Laceration Repair

Laceration repair

Definition

Laceration repair includes all the steps required to treat a wound in order to promote healing and minimize the risks of infection, premature splitting of sutures (dehiscence), and poor cosmetic result.

Purpose

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.

A laceration should be repaired if it:

• Continues to bleed after application of pressure for 10–15 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.

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 four goals of laceration repair are to stop bleeding, prevent infection, preserve function, and restore appearance.

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. Most lacerations are anesthetized by local injection of lidocaine, with or without epinephrine, into the wound edges. Lidocaine without epinephrine is used in areas with limited blood supply such as fingers, toes, ears, penis, and nose, because epinephrine could cause constriction of blood vessels (vasoconstriction) and interfere with the supply of blood to the laceration site. Alternatively, a topical anesthetic combination such as lidocaine, epinephrine, and tetracaine may also be used.

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 animal bite, if it is very dirty, or if the patient has a medical condition that alters wound healing, a broad-spectrum antibiotic may be prescribed.

Diagnosis/Preparation

Preparation for laceration repair involves inspecting the wound and the underlying tendons or nerves to evaluate the risk of infection, the degree of tissue damage, the need for debridement, and its complexity. If hair is located in or around the wound, it is usually removed to minimize contamination and allow for good visibility of the wound. If nerves or tendons have been injured, a surgeon may be needed to complete the repair.

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 three to 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 examined 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.

Risks

The most serious risk associated with laceration repair is infection. Risk of infection depends on the nature of the wound and the type of injury sustained. Infection risks are increased in wounds that are contaminated with soil or fecal matter, are the result of bites, have been open longer than one hour, or are located on the extremities or on the region between the thighs, genitalia, or other areas where opposing skin surfaces touch and may rub.

Normal results

All lacerations will heal with a scar. Wounds that are repaired with sutures are less likely to develop scars that are unsightly, but it cannot be predicted how wounds will heal and who will develop unsightly scars. Plastic surgery can improve the appearance of many scars.

Alternatives

The only alternative to laceration repair is to leave the wound without medical treatment. This increases the risk of infection, poor healing, and an undesirable cosmetic result.

See also Debridement.

Resources

books

snell, george. "laceration repair." in procedures for primary care physicians, edited by john l. pfenninger and grant c. fowler. st. louis: mosby, 1994.

periodicals

beredjiklian, p. k. "biologic aspects of flexor tendon laceration and repair." the journal of bone and joint surgery 85-a (march 2003): 539–550.

gordon, c. a. "reducing needle-stick injuries with the use of 2-octyl cyanoacrylates for laceration repair." journal of the american academy of nurse practitioners 13 (january 2001): 10–12.

klein, e. j., d. s. diekema, c. a. paris, l. quan, m. cohen, and k. d. seidel. "a randomized, clinical trial of oral midazolam plus placebo versus oral midazolam plus oral transmucosal fentanyl for sedation during laceration repair." pediatrics 109 (may 2002): 894–897.

pratt, a. l., n. burr, and a. o. grobbelaar. "a prospective review of open central slip laceration repair and rehabilitation." the journal of hand surgery: journal of the british society for surgery of the hand 27 (december 2002): 530–534.

singer, a. j., j. v. quinn, h. c. thode jr., and j. e. hollander. "determinants of poor outcome after laceration and surgical incision repair." plastic and reconstructive surgery 110 (august 2002): 429–437.

organizations

the association of perioperative registered nurses, inc. (aorn). 2170 south parker rd, suite 300, denver, co 80231-5711. (800) 755-2676. <http://www.aorn.org/>.

other

"cuts and scrapes." mayo clinic online. <http://www.mayoclinic.com/invoke.cfm?objectid=fdefd23a-f29f-47fb-9a7cd4cf4427d590>.

"a systematic approach to laceration repair." postgraduate medicine page. <http://www.postgradmed.com/issues/2000/04_00/wilson.htm>.

"wound repair." family practice notebook. <http://www.fpnotebook.com/sur18.htm>.

Mary Jeanne Krob, MD, FACS
Monique Laberge, PhD

WHO PERFORMS THE PROCEDURE AND WHERE IS IT PERFORMED?

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Primary care physicians, emergency room physicians, and surgeons usually repair lacerations. All physicians are trained in the basics of wound assessment, cleansing, and anesthesia. They are also familiar with the basic suturing techniques and have the experience required to attend to the details of wound repair, such as proper selection and preparation of equipment, careful wound preparation, appropriate use of specific closure methods, and effective patient education, required to avoid wound infection and excessive scarring.

Laceration repair is routinely performed in hospitals and clinics on an outpatient basis.

QUESTIONS TO ASK THE DOCTOR

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• How will my wound be repaired?
• Will the procedure hurt?
• How can I avoid infection after surgery?
• Will I be able to wash the wound?
• What are the possible complications?
• How long will it take to heal?
• Will there be a scar?
• When can the sutures be removed?