Laceration Repair (Wound Repair)

Pronounced: Lass-er-ae-shun repair

Definition

A laceration is a wound that occurs when skin, tissue, and/or muscle is torn or cut open. Lacerations may be deep or shallow, long or short, and wide or narrow. Most lacerations are the result of the skin hitting an object, or an object hitting the skin with force. Laceration repair is the act of cleaning, preparing, and closing the wound.

Parts of the Body Involved

Lacerations can occur on any part of the body. Here are common areas for lacerations:

  • Scalp, face, ears, neck
  • Torso
  • Legs, arms
  • Hands, feet

Reasons for Procedure

Minor lacerations (shallow, small, not bleeding, and clean) may not require medical attention. Antibiotic ointment and a bandage may be all that is needed. However, most lacerations do require repair. Reasons for seeking medical attention include the following:

  • Muscle, fat, tendon, or bone is exposed
  • Dirt and debris can be seen in the wound
  • Bleeding continues after applying direct pressure for 10-15 minutes
  • Edges of the wound are jagged or uneven
  • Wound is more than 1/8 to 1/4 inch deep
  • Edges of the wound cannot easily be moved together or aligned
  • The wound is located at an area of high stress (joints, hands, feet, chest)
  • Decrease risk of unsightly scarring

Note: If you are not sure if a wound needs to be repaired, go to the hospital and ask a doctor or nurse.

Risk Factors for Complications During the Procedure The following factors may increase risk of complications: Illnesses that may affect blood clotting (eg, hemophilia , renal failure ) Illnesses that cause the immune system to be suppressed Allergies to antibiotics or local anesthetics Dirty, old, or contaminated wounds Bite wounds (especially human bites) or wounds longer than five centimeters (about two inches), due to high infection rates What to Expect Prior to Procedure Preparing to Go to the Hospital Stop the bleeding: Apply direct pressure to the wound with gauze, a clean cloth, plastic bags, or, as a last resort, with a clean hand. If the wound bleeds through the gauze or cloth, do not remove it, simply add more absorptive material. Elevate the wound above the heart if possible to make it harder for blood to flow to the wound. Do not tie a tourniquet around an affected limb as it may cause more damage to the wound. If an artery was cut, apply pressure to the artery to stop bleeding. Stabilize the injured person: If the person feels faint, have them lay down with their feet slightly elevated or sit with their head between their knees. Help the person to the car so they can be caught if they faint. Stop the wound from bleeding. If muscle, tendon, bone, or organs are exposed, do not try to push them back into place. At the Hospital The doctor will likely do the following:
Examine the wound Assess your age and cooperation Decide if a surgeon is needed Ask about your medical history, allergies, and how the wound occurred (bite wounds may require extra antibiotics and shots) Discuss your pain tolerance and preferred method of wound closure Explain the procedure Anesthesia Anesthesia numbs the body temporarily so pain and discomfort are not felt. Anesthesia use depends on the size and nature of the laceration and on the desires of the patient. Typically, local anesthesia is given prior to laceration repair. Minor lacerations may not require any anesthesia, or you may choose to opt out of anesthesia. In some instances, general anesthesia may be required for severe lacerations. Your doctor will help you decide what is right for you. Local anesthesia Injected around wound edges before stitches, staples, adhesive strips, or glue is applied Only the area where the anesthetic is applied loses feeling Consciousness is not lost General anesthesia Can be used when a laceration is severe, large, and/or fat, muscle, or organs are exposed May also be used for uncooperative or panicked individuals Medication is given intravenously (IV) Entire body is numbed Consciousness is lost Description of the Procedure Cleaning and preparing a laceration for repair is crucial for preventing infection and reducing the appearance of scaring. Cleaning not only washes away dirt, but also removes the germs that could trigger infection. Cleaning is done in the same manner regardless of the technique that will be used for wound closure. Preparation is done to even out jagged edges so that scarring may be less noticeable. Preparation is done as needed.
Cleaning Hair that will interfere with wound closure and healing will be trimmed or smoothed flat. Sterile saline solution is squirted in the wound to wash away dirt and debris (done with a syringe or with a bottle). Antiseptic or mild soap may also be used if the wound is deep and dirty. This may be done before or after anesthesia is given. Preparing Jagged edges may be cut away so the wound can heal with a less noticeable scar. Damaged or dead tissue will be removed to prevent infection. This is typically done after anesthesia is given. Closing Once the wound is sterile and dry, the wound may be closed. There are several ways to close a laceration. The technique used depends on the characteristics of the laceration, the location of the laceration, and the doctor or surgeons comfort level with a certain technique. Dermabond (Glue): Dermabond is used on the face, arms, legs, torso, and on lacerations smaller than six centimeters long. It is not used for lips, lacerations that are over joints, deep lacerations, or most hand and foot lacerations. The doctor will hold the wound shut and apply a thin layer of Dermabond. Warmth may be felt as the glue sets up. Dermabond is applied in three coats with a 30-second wait in between coats. The wound is then held in place for 60 seconds.
Depending on the cause and location of the wound, a dry bandage may be applied. This technique is less frightening for children because no needles are required. In some cases, this technique may be used along with subcutaneous (under the skin) stitches. Note: The glue acts like a protective coat and is not placed in the wound, or in between the edges of the wound. Do not attempt to use super glue or any other glue to repair lacerations on your own. Getting glue into wounds may prevent the wound from healing properly. Steristrips (Adhesive Strips): Steristrips are used for minor lacerations that are clean, have relatively straight edges that match up, and are easy to push closed. The wound is aligned, and adhesive strips are applied perpendicularly across the wound like tape. Sutures (Stitches): Sutures are used for wounds that are deep, bleeding, have jagged edges, or have fat or muscle exposed. Iodine is applied to the wound edges, and to the skin surrounding the wound. A surgical drape may be positioned over the wound, and taped to the skin so it does not move around (keeps the area sterile). If a laceration is deep and underlying tissue or muscle is also lacerated, stitches may be needed under the skin before the wound can be closed. This will rejoin muscle and tissue layers. The stitches used under the skin are absorbed by the body, and do not need to be removed.
If a wound is not deep, or the suturing under the skin is finished, the wound can be stitched shut. Once the wound is closed, saline is used to clean the area, and a thin layer of antiseptic ointment may be applied to protect from germs. A gauze pad may be placed over the stitches and an elastic bandage or tape may be used to cover and protect. Staples: Staples are best suited for the scalp, neck, arms, legs, torso, and buttocks. Iodine is applied to the skin surrounding the wound, and the wound edges are closed and aligned. Staples are placed every centimeter along the wound with two at the center of the wound for strength. The staple line is cleansed with saline, patted dry, and an antibiotic ointment is applied. A clear acrylic dressing called Tegaderm is applied to the staple line, and then a gauze pad and tape are used to secure the wound. Hair Tying: Hair tying is used for some scalp lacerations. Hair is gathered in a way that pulls the wound shut. The hair is then rubber banded so the wound remains shut. This technique follows the same principal as stitches without having to penetrating the skin. After Procedure You will receive instructions on how to care for the wound. Pain medication will be prescribed to manage discomfort. Blood tests will be performed, usually for dirty or bite-inflicted lacerations, to make sure disease was not spread. Antibiotics will be prescribed if the laceration is the result of a bite, was very dirty, or if the person is sick or has a weakened immune system. Tetanus booster will be given if the laceration is deep or dirty and the last tetanus shot was given more than five years ago. How Long Will It Take? The amount of time laceration repair will take depends on the severity, size, location, and cleanliness of the laceration. Repair may take less than 15 minutes or more than an hour.
Will It Hurt? Laceration repair may hurt. The doctor needs to examine and clean the wound. If anesthetic is given before closing the wound, pain should not be felt during that part of the procedure. Also, if the laceration is minor, and glue or adhesive is used, laceration repair should not hurt very much. Possible Complications Infection: Infection may occur for several reasons. First, the wound may not have been fully cleaned of microscopic bacteria (germs). Second, the wound may have been allowed to age and fester before treatment was sought. Third, the wound may not have been properly cared for after leaving the hospital. Decrease your risk of infection by getting your laceration cleaned and repaired shortly after injury. Wounds that are more than eight hours old may not be able to be repaired due to the higher risk of infection. Also, follow you doctors instructions for wound care. Noticeable Scarring: All lacerations heal with scars of varying visibility. Noticeable scarring may be the result of the way the body healed itself, trying to fix the wound without medical care, or the doctors skill level and choices. Decrease your risk of severe scarring by allowing a doctor or surgeon to repair the wound, and by allowing the wound to heal without picking or rubbing it. Dehiscence (Tearing Open the Incision): The location and severity of the wound may cause opening of the incision. Also, putting stress on the repaired laceration, or using the wrong closure material can result in splitting. Decrease your risk by avoiding strenuous activities that could cause the repaired laceration to split open or tear, and allow your doctor to use the method he or she thinks is best for closing the wound. Allergic Reaction: Allergic reaction may result from exposure to antibiotics, ointment, lidocaine (in the anesthesia), or to adhesive bandages. To reduce you risk of reaction, tell your doctor about your allergies. Different antibiotics, ointment, and anesthetic can be chosen, and adhesive-free bandages can be used. Average Hospital Stay Laceration repair does not usually require a stay in the hospital. Other injuries that may have been caused at the same time as the laceration may require a hospital stay.
Postoperative Care Follow your doctors instructions Set up follow-up appointments as needed. Do not participate in physically demanding activities unless approved by your doctor. Take antibiotics and pain medications exactly as directed. Bathing If you receive stitches or staples, short baths may be allowed after 24 hours as long as the wound is not soaking. Dermabond is water resistant, you may be able to shower without restriction. Showering will not affect banded hair (see your doctors instructions for washing hair). If you are not sure about whether your incision should get wet, use a plastic bag wrapped around the site to keep it dry during showers. Note: After showering or bathing, pat the wounded area dry. Do not rub the area. Also, do not apply hydrogen peroxide or iodine to the wound. This will damage tissue and slow healing. Removal of wound closure material Dermabond will fall off by itself in 5 to 10 days. Adhesive tape will typically be removed after 5 to 10 days, or be allowed to fall off on its own. Your doctor will remove stitches anywhere from five days to three weeks after you receive them (late removal of stitches can cause scarring). Staples may be removed after 5 to 10 days. Rubber bands may be cut from hair in 7 to 10 days. Note: Do not try to remove any wound closure material. The doctor will remove stitches, tape, and staples. Dermabond will peel off by itself. Removing materials yourself may lead to infection, scarring, or reopening of the wound.
Outcome Wounds begin to heal immediately, although visible signs of healing may take a few days to several weeks to become apparent. Younger individuals may heal faster than older individuals, and healthier individuals may heal faster than individuals with illnesses. Total healing will not be complete for six months. All lacerations heal with scars. The degree of scarring differs from person-to-person, and depends on the location, type, and size of the wound. Further, the skill of the doctor, and the choices made by both the doctor and the patient can play a role in healing. For example, poor alignment of the edges of the wound before closing the wound may create a more noticeable scar. Also, picking at a wound, scratching, and participating in restricted activity may also lead to poor healing. If a noticeable scar does result, plastic surgery may be used to decrease the scars appearance. Call Your Doctor If Any of the Following Occurs It is essential for you to monitor your recovery once you leave the hospital. That way, you can alert your doctor about any problems immediately. If any of the following occur, call your doctor: Redness or red lines around the wound Swelling Drainage Fever Chills Warmth felt around the wound Bleeding RESOURCES:
American Academy of Family Physicians http://www.aafp.org National Library of Medicine http://www.nlm.nih.gov/ CANADIAN RESOURCES: Canadian Association of Wound Care http://www.cawc.net/open/wcc/index.html SkinCareGuide.ca http://www.skincareguide.ca References: Burns T, Worthington J. Using tissue adhesive for wound repair: a practical guide to Dermabond. American Academy of Family Physicians website. Available at: http://www.aafp.org/afp/20000301/1383.html . Accessed September 15, 2005. Cuts and scrapes. Mayoclinic.com website. Available at: http://www.mayoclinic.com/invoke.cfm?objectid=FDEFD23A-F29F-47FB-9A7CD4CF4427D590 . Accessed September 15, 2005. Laceration. Allina Hospitals and Clinic website. Available at: http://www.medformation.com/ac/mm_qdis.nsf/qd/nd0730g.htm . Accessed September 15, 2005. Perron AD, et al. The efficacy of cyanoacrylate-derived surgical adhesive for use in the repair of lacerations during competitive athletics. Am J Emerg Med . 2000; 18:261-263. Quinn J, et al. Tissue adhesive versus suture wound repair at 1 year: randomized clinical trial correlating early, 3-month, and 1-year cosmetic outcome. Ann Emerg Med . 1998; 32:645-649. Snell G. Laceration Repair: Procedures for Primary Care Physicians . St. Louis, MO: Mosby; 1994.
Wilson J, Kocurek K, Doty J. A systematic approach to laceration repair: tricks to ensure the desired cosmetic results. Postgraduate Medicine Online website. Available at: http://www.postgradmed.com/issues/2000/04_00/wilson.htm . Accessed September 15, 2005. Last reviewed January 2008 by Ronald Nath, MD Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.
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