Surgery Book

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Wound RepairAka: Laceration Repair, Laceration

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  1. See Also
    1. Wound
    2. Marine Trauma
    3. Puncture Wound
  2. Repair timetable
    1. Primary Repair (bacterial count increased by 3 hours)
      1. Face: Repair within 24 hours (18 hours preferred)
      2. Body: Repair within 18 hours (6 hours preferred)
    2. Healing by second intention
      1. Pack wounds with sterile wet to dry dressing bid
      2. Granulation and Contraction risk without suturing
  3. Relative contraindications to primary wound closure
    1. Infected and inflamed wounds
    2. Human Bite or Animal Bite
    3. Serious crush wounds
    4. Primary repair time constraints above not met
  4. Anesthesia Pearls to decrease patient discomfort
    1. See Local Skin Anesthesia
  5. Irrigation
    1. Saline as efficacious as 1% betadine for irrigation
    2. Moderate pressure irrigation is the key
      1. Irrigation with syringe provides approximately 7 psi
      2. Use 35 ml syringe with 19 gauge needle
      3. Irrigate with minimum of 500 to 1000 cc
    3. Avoid irrigation with tissue destructive agents
      1. Hydrogen peroxide (weak germacide)
      2. Betadine at stock concentration (9%)
        1. Always dilute betadine (1:10)
  6. Wound Preparation
    1. Remove all foreign bodies with scrub brush
    2. Apply Betadine 1% or other topical antiseptic
      1. Avoid hibiclens near eyes
    3. Drape widely to allow clear margins
    4. Scalp Wounds
      1. Slick surrounding hair down with K-Y Jelly
  7. Materials
    1. See Suture Material
    2. See Tissue Adhesive
    3. Tape closure (Steri-strip) with Benzoin
      1. Remains attached for 4 days
      2. Lower risk of wound infection
      3. Place an extra steri-strip across each of strip ends
    4. Staples
      1. Indicated on scalp and abdomen (tendons, nerves deep)
    5. Instrument pointers
      1. Use pickups with teeth (less crush injury)
    6. Gloves
      1. Sterile gloves not needed in uncomplicated repair
      2. Perelman (2004) Ann Emerg Med 43:362
  8. Wound Repair
    1. Specific injury approaches
      1. See Finger Laceration
      2. See Wound Dressing for Transport
        1. Indicated if repair must be done elsewhere
    2. Debridement
      1. Recut wound for clean, fresh, surgical-incision edges
    3. Undermining
      1. Ensures Dermis closure
    4. Suture technique: Interupted simple mneumonic
      1. Not too many
      2. Not too tight
      3. Not too wide
      4. Get them out
    5. Bandages: Moist wound healing is key
      1. Non-adherent slightly moist dressings
      2. Ointment or Topicals (e.g. Bacitracin)
        1. Apply for first 3 days until epithelialization
      3. Consider debridement after epitheliaztion (day 3)
        1. Carefully apply 50% hydrogen peroxide to scab
        2. Avoid prior to day 3 (delays wound healing)
        3. Scab removal may improve cosmesis
      4. Gentle compression
      5. Limited bathing may begin >24 hours after repair
  9. Wound Repair: Scalp Repair (Hair Apposition Technique)
    1. Indications
      1. Linear scalp laceration <10 cm
      2. Minimum of 3 cm scalp hair
      3. Clean wound
    2. Technique
      1. Pull Hair on both sides of wound together
      2. Twist hair together with single twist
      3. Secure hair with tissue glue
    3. Follow-up
      1. Hair may be washed after 48 hours of procedure
    4. Advantages
      1. Less scarring than with standard suturing
      2. No shaving or suturing needed
      3. No increased risk of infection or bleeding
    5. References
      1. Ong (2002) Ann Emerg Med 40:19
  10. Suture Removal
    1. See Suture for timing of Suture removal
  11. Management Adjunts
    1. Prophylactic antibiotics possible indications
      1. See secondary infection risk factors below
      2. Endocarditis risk (see SBE Prophylaxis)
      3. Hip prosthesis
      4. Not routinely indicated in noncontaminated wounds
    2. Tetanus Toxoid booster
      1. Unknown Immune Status or never immunized
        1. Tetanus Toxoid 0.5 nl now, at 6 weeks and 6 months
        2. Tetanus Immune globulin 250 U if dirty wound
      2. Last Tetanus Toxoid over 5-10 years prior
        1. Tetanus Toxoid 0.5 ml
  12. Complications: Secondary wound infection
    1. Occurs within 48 hours
    2. Risk factors
      1. Contaminated wound (manure, dirt, rust)
      2. Bite Injury
      3. Crush Injury
      4. Prolonged time to skin closure (see above)
      5. Underlying medical condition
        1. Diabetes Mellitus
        2. Chemotherapy
        3. Corticosteroids
        4. Malnutrition
        5. Lymphedema
        6. Peripheral Vascular Disease
  13. Course of wound healing
    1. See Wound

Laceration (C0043246)

Definition (MSH)Torn, ragged, mangled wounds.
ConceptsInjury or Poisoning (T037)
EnglishLaceration, Lacerations, Tear
Spanishdesgarro, laceración, laceracion
CreditsDerived from the NIH UMLS (Unified Medical Language System)



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