Laceration repair
Laceration repair refers to the medical procedure used to treat jagged or torn wounds, commonly found on the skin but potentially affecting any tissue. These wounds often result from sharp objects or accidents involving machinery or animals. The immediate priorities in laceration repair include stopping any bleeding and cleaning the wound to minimize infection risk. This involves applying direct pressure, removing foreign debris, and debriding any devitalized tissue. Once the wound is properly cleaned and treated, it is closed using various methods such as sutures, staples, or adhesive tape, depending on the wound's location and the patient's age.
Post-repair, it is essential to monitor the site for potential complications such as infection or scarring, particularly for facial wounds where cosmetic outcomes are a concern. Techniques that prioritize good surgical practices and postoperative care can help mitigate these risks. Laceration repair is a critical skill utilized across various medical settings, emphasizing the importance of both functionality and appearance in wound healing.
Laceration repair
Anatomy or system affected: Skin
Definition: The closure of an irregular skin wound
Indications and Procedures
A laceration is a jagged, torn, mangled, or ragged wound. This type of wound is most commonly encountered in the skin, although any tissue may be lacerated. Lacerations are caused by sharp objects such as a piece of metal, glass, or a stick. They may also occur in accidents involving machinery or animals.
The first priority in laceration repair is to stop the bleeding, thereby minimizing blood loss. This is usually accomplished by applying pressure either directly on the wound or on the injured blood vessel nearest the injury site.
The second priority with a laceration is to clean the wound, which involves the removal of any foreign material or debris. With penetrating injuries, this cleaning must be done carefully, lest the removal of the object initiate bleeding. Tissue that has been destroyed beyond the body’s ability to repair it must also be removed; this process is called debridement. Devitalized tissue is removed to prevent infection. The wound site is then cleaned via irrigation with saline and a disinfectant, usually a mild soap or a chemical.
After the laceration has been cleaned, it may then be treated for bacterial or other pathogenic contamination. Aqueous solutions containing an antibiotic are used with most wounds. If contamination with other pathogens is suspected, appropriate agents are used to rinse the wound. Antibiotic powders may be employed in field conditions, although this form of treatment is unusual in a hospital setting. Other than soap and water, there is no special treatment for viral contamination.
Closure of the wound is then completed. The edges are brought together and may be held in place with forceps. Often sutures, or stitches, are inserted to hold the edges together while the tissue heals. On skin surfaces, these sutures are usually nonabsorbable and are later removed. The amount of time that sutures are kept in place varies with the location of the wound and the age of the patient; mucous membranes heal more quickly than the palm, for example, and children’s skin heals more rapidly than that of adults. Removable sutures are made of nylon or a similar material. Sutures that are used beneath the skin cannot be removed and are made of material that will break down within the body. Wound closure may also be accomplished with wire, staples, or adhesive tape. These materials have both advantages—durability (wire), ease of placement (staples), and minimal pain (tape)—and disadvantages, such as potential contamination (wire) and accidental premature removal (tape). Lacerations should be rechecked by a physician when sutures or other means of wound closure are removed.
Uses and Complications
The techniques of laceration repair are used on all parts of the body where such wounds occur. Plastic surgery may be required to improve the appearance of the repaired tissue and to reduce scars when the patient believes that cosmetic results are an issue. In addition to scarring, other complications that may be associated with the repair of lacerations include infection and tetanus. All these problems can be minimized through good surgical techniques, the use of antibiotics, and careful postoperative care. The repair of lacerations to exposed facial skin is especially important. Careful technique minimizes scarring, as do some new methods of wound closure.
Bibliography
American Academy of Orthopaedic Surgeons. Emergency Care and Transportation of the Sick and Injured. 11th ed., Jones & Bartlett Learning, 2017.
American Red Cross and Kathleen A. Handal. The American Red Cross First Aid and Safety Handbook. Little, Brown, 1992.
Forsch, Randall T. et al. “Laceration Repair: A Practical Approach.” American Family Physician, vol. 95, no. 10, 2017, pp. 628-636.
“Laceration: Sutures or Staples—At Home.” MedlinePlus, US National Library of Medicine, 15 Jan. 2016, medlineplus.gov/ency/patientinstructions/000498.htm. Accessed 9 Jan. 2017.
“Lacerations: Liquid Bandage.” MedlinePlus, US National Library of Medicine, 21 Jan. 2016, medlineplus.gov/ency/patientinstructions/000497.htm. Accessed 9 Jan. 2017.
Mulholland, Michael W., et al., editors. Greenfield’s Surgery: Scientific Principles and Practice. 6th ed., Wolters Kluwer, 2017.
Patterson, James W. Weedon's Skin Pathology. 4th ed., Elsevier, 2016.
Rymaruk, Jen. “Laceration Repair.” Health Library, EBSCO Information Services, 20 Dec. 2014, healthlibrary.epnet.com/GetContent.aspx?token=D39207C8-9100-4DC0-9027-9AC6BA11942D&chunkiid=101013. Accessed 9 Jan. 2017.
Trott, Alexander T. Wounds and Lacerations: Emergency Care and Closure. 4th ed., Elsevier, 2012.