Laceration repair: Difference between revisions
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[[Category:Procedures]] | [[Category:Procedures]] |
Revision as of 00:51, 15 June 2015
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 & suture 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 18 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
- Put LET in open wound, EMLA on intact skin (doesn't work in open wound)
- Check motor/sensory before give anesthesia
- To decrease pain of injection:
- Buffer lidocaine with bicarbonate (1mL bicarb:9mL lidocaine)
- Inject slowly
Maximum Doses of Anesthetic Agents
Agent | Without Epinephrine | With Epinephrine | Duration | Notes |
Lidocaine | 5 mg/kg (max 300mg) | 7 mg/kg (max 500mg) | 30-90 min |
|
Mepivicaine | 7 mg/kg | 8 mg/kg | ||
Bupivicaine | 2.5 mg/kg (max 175mg) | 3 mg/kg (max 225mg) | 6-8 hr |
|
Ropivacaine | 3 mg/kg | |||
Prilocaine | 6 mg/kg | |||
Tetracaine | 1 mg/kg | 1.5 mg/kg | 3hrs (10hrs with epi) | |
Procaine | 7 mg/kg | 10 mg/kg | 30min (90min with epi) |
Exploration
- Ideally done in bloodless field
- Look for foreign bodies, tendon tears, or fracture
- Glass in wound = need for xray
Suturing
- See Sutures
Aftercare
- Antibiotics
- Consider for:
- Wounds contaminated by debris or feces
- Caused by punctures or bites
- Tissue destruction or in avascular areas
- Neglected wounds
- Wounds contaminated by fresh water and plantar puncture wounds through athletic shoes should include Pseudomonas coverage
- Consider for:
- 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 or < 3 doses given
- Require f/u Tdap @ 1mo & 1 yr; age>60 = high risk of poor immunization
- Dressing
- Keep moist, not wet
- Bandaid, xeroform, or ointment
- Keep moist, not wet
- Wound check
- 48-72 hrs ONLY if high risk wound
- No point in checking before 48hr (takes this long for infection to occur)
- 48-72 hrs ONLY if high risk wound