Laceration Repair Health Article

Definition

Laceration repair includes all the steps required to treat a wound in order to promote healing and minimize the risks of infection, premature splitting of sutures (dehiscence), and poor cosmetic result.

Purpose

A laceration is a wound caused by a sharp object producing edges that may be jagged, dirty, or bleeding. Lacerations most often affect the skin, but any tissue may be lacerated, including subcutaneous fat, tendon, muscle, or bone.

A laceration should be repaired if it:

• Continues to bleed after application of pressure for 10–15 minutes.
• Is more than one-eighth to one-fourth inch deep.
• Exposes fat, muscle, tendon, or bone.
• Causes a change in function surrounding the area of the laceration.
• Is dirty or has visible debris in it.
• Is located in an area where an unsightly scar is undesirable.

Lacerations are less likely to become infected if they are repaired soon after they occur. Many physicians will not repair a laceration that is more than eight hours old because the risk of infection is too great.

Description

Laceration repair mends a tear in the skin or other tissue. The four goals of laceration repair are to stop bleeding, prevent infection, preserve function, and restore appearance.

The laceration is cleaned by removing any foreign material or debris. Removing foreign objects from penetrating wounds can sometimes cause bleeding, so this type of wound must be cleaned very carefully. The wound is then irrigated with saline solution and a disinfectant. The disinfecting agent may be mild soap or a commercial preparation. An antibacterial agent may be applied.

Once the wound has been cleansed, the physician anesthetizes the area of the repair. Most lacerations are anesthetized by local injection of lidocaine, with or without epinephrine, into the wound edges. Lidocaine without epinephrine is used in areas with limited blood supply such as fingers, toes, ears, penis, and nose, because epinephrine could cause constriction of blood vessels (vasoconstriction) and interfere with the supply of blood to the laceration site. Alternatively, a topical anesthetic combination such as lidocaine, epinephrine, and tetracaine may also be used.

The physician may trim edges that are jagged or extremely uneven. Tissue that is too damaged to heal must be removed (debridement) to prevent infection. If the laceration is deep, several absorbable stitches (sutures) are placed in the tissue under the skin to help bring the tissue layers together. Suturing also helps eliminate any pockets where tissue fluid or blood can accumulate. The skin wound is closed with sutures. Suture material used on the surface of a wound is usually non-absorbable and will have to be removed later. A light dressing or an adhesive bandage is applied for 24–48 hours. In areas where a dressing is not feasible, an antibiotic ointment can be applied. If the laceration is the result of a human or animal bite, if it is very dirty, or if the patient has a medical condition that alters wound healing, a broad-spectrum antibiotic may be prescribed.