Laceration repair

Indications

• Do not close body wounds >12 hr old
• Do not close face/scalp wounds >24 hr old
• If don't close, prepare wound as if going to close:
  • Irrigate, explore, non-adherent or vaseline gauze to prevent wound edges from closing
  • Wrap, consider oral abx
  • On Day 3 remove packing, irrigate & sew if appears clean

Wound Preparation

• Debridement is most important step in reducing infection/ promoting healing
• Avoid betadine/chlorhexadine in wound
• Not necessary to remove hair (if do, avoid using razor)

Irrigation

• High pressure irrigation is best (can be achieved with 19 gauge syringe)
• Tap water is as effective as sterile water/ normal saline
• Irrigation optional for face/scalp wound as long as:
  • Not a bite wound
  • Not a contaminated wound
  • Not older than 6 hours

Anesthesia

• NO epi if fingers, nose, toes, or penis
• Put LET in open wound, EMLA on intact skin (doesn't work in open wound)
• Check motor/sensory before give anesthesia!

• Lidocaine (1% solution (10mg/mL)
  • Maximum safe dose = 300mg
• Lidocaine + epinephrine
  • Maximum safe dose = 500mg
  • Delays healing, increases infection risk?
• Bupivicaine (0.25%)
  • Maximum safe dose = 175mg
  • Do not buffer with bicarbonate
• Bupivicaine + epinephrine
  • Maximum safe dose = 225mg

• To decrease pain of injection:
  • Buffer lidocaine with bicarbonate (1mL bicarb:9mL lidocaine)
  • Inject slowly

Exploration

• Look for foreign bodies or fracture
• Glass in wound = xray

Suturing

See: Sutures

Aftercare

• Splinting
  • Wounds over flexor surfaces or tension
• Tetanus
  • Tdap 0.5cc IM to pts >7y w/ no booster w/in 5 yr
  • Hypertet 250 u IM @ diff site from Tdap if NO Hx of Td
    • Require f/u Tdap @ 1mo & 1 yr; age>60 = high risk of poor immunization
• Dressing
  • Keep moist, not wet
    • Bandaid, xeroform, or ointment
• Wound check
  • 48-72 hrs ONLY if high risk wound
    • No point in checking before 48hr (takes this long for infection to occur)

See Also

Sutures

Source

UpToDate