Laceration repair: Difference between revisions
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==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 | |||
==Anesthesia== | ==Anesthesia== | ||
*Lidocaine (1% solution (10mg/mL) | *Lidocaine (1% solution (10mg/mL) |
Revision as of 07:46, 5 April 2011
==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
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
- Bupivicaine + epinephrine
- Maximum safe dose = 225mg
- To decrease pain of injection:
- Buffer lidocaine with bicarbonate (1mL bicarb:9mL lidocaine)
Skin Preparation
- Avoid betadine/chlorhexadine in wound
- Not necessary to remove hair (if do, avoid using razor)
Wound Preparation
- Debridement is most important step in reducing infection/ promoting healing
- 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
See Also
Source
UpToDate