LACERATION REPAIR
Category: Plastic Surgery
Abstract : Laceration repair 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 s
Laceration repair
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 broadspectrum antibiotic may be prescribed.
Diagnosis / Preparation
Preparation for laceration repair involves inspecting the wound and the underlying tendons or nerves to evaluate the risk of infection, the degree of tissue damage, the need for debridement, and its complexity. If hair is located in or around the wound, it is usually removed to minimize contamination and allow for good visibility of the wound. If nerves or tendons have been injured, a surgeon may be needed to complete the repair.
Aftercare
The laceration is kept clean and dry for at least 24 hours after the repair. Light bathing is generally permitted after 24 hours if the wound is not soaked. The physician will provide directions for any special wound care. Sutures are removed three to 14 days after the repair is completed. Timing of suture removal depends on the location of the laceration and physician preference. The repair should be examined frequently for signs of infection, which include redness, swelling, tenderness, drainage from the wound, red streaks in the skin surrounding the repair, chills, or fever. If any of these occur, the physician should be contacted immediately.
Risks
The most serious risk associated with laceration repair is infection. Risk of infection depends on the nature of the wound and the type of injury sustained. Infection risks are increased in wounds that are contaminated with soil or fecal matter, are the result of bites, have been open longer than one hour, or are located on the extremities or on the region between the thighs, genitalia, or other areas where opposing skin surfaces touch and may rub.
Normal results
All lacerations will heal with a scar. Wounds that are repaired with sutures are less likely to develop scars that are unsightly, but it cannot be predicted how wounds will heal and who will develop unsightly scars. Plastic surgery can improve the appearance of many scars.
Alternatives
The only alternative to laceration repair is to leave the wound without medical treatment. This increases the risk of infection, poor healing, and an undesirable cosmetic result.
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