by Rymaruk J
Laceration Repair
(Wound Repair)
Definition
A laceration is a tear or cut in the skin, tissue, and/or muscle. They can vary in length, depth, and width. A laceration repair is the act of cleaning, preparing, and closing the wound.
Reasons for Procedure
Lacerations that are shallow, small, not bleeding, and clean may not need medical care. Antibiotic ointment and a bandage may be all that is needed.
Lacerations may need medical repair if it has:
- Exposed muscle, fat, tendon, or bone
- Dirt and debris in the wound, may remain even after cleaning
- Feeling as if something is in the laceration, even if you cannot see any debris
- Bleeding continues after applying direct pressure for 10-15 minutes
- Jagged or uneven edges
- Depth more than 1/8 to 1/4 inch deep
- Location on area of high stress (joints, hands, feet, chest)
Wounds may also need medical care if there is risk of
tetanus
. This is a bacterial infection from dirt, dust or feces. Factors that increase your risk of tetanus include a deep wound or contamination with dirt, saliva, or feces.
Medical care may also be used if there is a worry about scarring.
Note:
If you are not sure if a laceration wound needs to be repaired, go to the hospital.
Possible Complications
If you have a laceration repair, your doctor will review a list of possible complications, which may include:
- Infection
- Bleeding
- Noticeable scarring
- Poor wound closure
- Allergic reaction to anesthetic
What to Expect
Prior to Procedure
To treat the laceration before you see the doctor:
- Apply direct pressure to the wound. Use gauze, a clean cloth, plastic bags, or, as a last resort, a clean hand. If the wound bleeds through the gauze or cloth, do not remove it. Add more gauze.
- If possible, elevate the wound above the heart. This will make it harder for blood to flow to the wound. Do not tie a tourniquet around an affected limb. This may cause more damage.
- If bleeding stops, let some water run over the wound. Tap water is safe to use.
- If muscle, tendon, bone, or organs are exposed, do not try to push them back into place.
- If you are feeling faint, lie down or sit with your head between your knees.
Once you are at the hospital, the doctor will likely do the following:
- Examine the wound
- Decide if a surgeon is needed
- Ask about your medical history, allergies, and how the wound occurred
- Discuss your pain tolerance and options for closing the laceration
- Explain the procedure
Anesthesia
This depends on the type of laceration, for example:
- Local anesthesia is used for minor lacerations. This will numb the area around the wound.
-
General anesthesia
may be needed for severe lacerations.
It will block pain and keeps you asleep.
In some cases, no anesthesia is needed.
Description of Procedure
The wound will be cleaned and prepared. Hair the may interfere will be trimmed and smoothed away. Sterile water will be squirted into the wound. This will help wash away dirt and debris. A soap or antiseptic may be used to clean to surface around the laceration.
If necessary, some jagged edges will be cut away. This may help the laceration close easier. Damaged or dead tissue will be removed to prevent infection.
The laceration will be closed once the wound is clean. There are several options to help close the wound:
Dermabond
Dermabond is a special glue that holds a wound together. It is used on the face, arms, legs, and torso. It can also be used on small lacerations. It is not used for lips, lacerations that are over joints, deep lacerations, or most hand and foot lacerations. The laceration will be held shut. Next, a thin layer of Dermabond will be applied over the area. Warmth may be felt as the glue sets. Dermabond will be applied in three coats. The wound will then be held in place for 60 seconds. A bandage may be placed over the area over the wound.
Note:
The glue sits on top of the laceration. It is not placed in the wound or between the edges of the wound. Never try to repair a wound at home with glue. Getting glue into wounds may prevent them from healing properly.
Steristrips
Steristrips are adhesive strips that help close the laceration. They may be used in lacerations that are clean, shallow, have straight edges, and are easy to push closed.
The doctor will align the edges of the wound. The strips will be applied across the wound.
Stitches
Stitches, are used for wounds that are deep, bleeding, have jagged edges, or have fat or muscle exposed. The area will be cleaned with iodine. A surgical drape may be positioned over the wound. This will keep the area sterile.
If a laceration is deep, stitches may be needed under the skin. The stitches used under the skin will be absorbed by the body. They will not need to be removed.
The wound will then be stitched shut. Once the wound is closed, saline will be used to clean the area. A thin layer of antiseptic ointment may be applied, as well. A gauze pad may be placed over the stitches. An elastic bandage or tape may be placed over the gauze to cover and protect them.
Staples
Staples are best suited for the scalp, neck, arms, legs, torso, and buttocks. Iodine will be applied to the skin surrounding the wound. The wound edges will be closed and aligned. Staples will be placed along the wound.
Saline will wash the staple line. The area will be patted dry. An antibiotic ointment will be applied. A clear acrylic dressing called Tegaderm will be placed over the staple line. A gauze pad and tape will be placed over the area.
Hair Tying
Hair tying is used for some scalp lacerations. Hair will be gathered in a way that pulls the wound shut. The hair will then be rubber banded or held together with dermabond so the wound remains shut.
Tetanus Vaccination
Some wounds may put you at a higher risk for a tetanus infection. A
tetanus vaccination
may be given if:
- You have never received a total of at least three vaccination doses.
(routine childhood
immunizations gives a dose at ages 2, 4, 6, and 15-18 months)
- It has been more than
five years since your last tetanus immunization.
- You are unsure of your tetanus status.
How Long Will It Take?
This depends on the laceration. It may take less than 15 minutes or more than an hour.
How Much Will It Hurt?
This also depends on the laceration. Severe lacerations will be very painful. Ask your doctor about pain medicine.
Post-procedure Care
At the Care Center
Following the procedure, the staff may provide the following care to make you more comfortable and help your recovery:
- Give you pain medicine and antibiotics.
-
Give you a
tetanus
booster.
At Home
When you return home, do the following to help ensure a smooth recovery:
- Avoid strenuous activities.
- Take antibiotics and pain medication as directed.
-
Ask your doctor about when it is safe to shower, bathe, or soak in water.
- If you need to keep the incision area dry when showering, wrap the area with a plastic bag.
- After showering or bathing, pat the area dry. Do not rub the area. Also, do not apply hydrogen peroxide or iodine to the wound. This will damage tissue and slow healing.
- Do not pick at or scratch the wound. This may lead to poor healing.
Removal of wound closure material
depends on the type of repair that you had:
- Dermabond will fall off in 5-10 days.
- Steristrips will typically be removed after 5-10 days, or they will fall off on their own.
- Stitches will be removed after 5-14 days.
- Staples will be removed after 5-10 days.
- Rubber bands will be cut from hair in 7-10 days.
Note:
Do not try to remove the closure material. Removing materials yourself may lead to infection, scarring, or reopening of the wound.
All lacerations heal with scars. The degree of scarring varies and is influenced by:
- A personal history of excessive scar (keloids) formation
- Location, type, and size of the wound
- Skill of the doctor
If a noticeable scar does result, plastic surgery may be used to decrease the scar’s appearance.
Call Your Doctor
After arriving home, contact your doctor if any of the following occurs:
- Wound reopens
- Redness, warmth, swelling, drainage or excessive bleeding occurs at the wound site.
- Signs of infection, including fever, chills, or red streaks tracking up arm or leg
- Spasm or rigidity of muscles in jaw, neck, abdomen, or an area near the wound
- Any other concerns
In case of an emergency, call for medical help right away.
RESOURCES
American Academy of Family Physicians
http://www.familydoctor.org/
National Library of Medicine
http://www.nlm.nih.gov/
CANADIAN RESOURCES
Canadian Association of Wound Care
http://www.cawc.net/
Skin Care Guide.ca
http://www.skincareguide.ca/
References
Beam, J. W. Wound Cleansing: Water or Saline?
J Athl Train.
2006;4(2):196-197.
Burns T, Worthington J. Using tissue adhesive for wound repair: a practical guide to Dermabond. American Academy of Family Physicians website. Available at:
http://www.aafp.org/afp/20000301/1383.html
. Published March 1, 2000. Accessed December 28, 2012.
Joyce MP. Routine Vaccine-Preventable Diseases - Tetanus. Centers for Disease Control and Prevention website. Available at:
http://wwwnc.cdc.gov/travel/yellowbook/2010/chapter-2/tetanus.aspx
. Updated July 1, 2011. Accessed December 28, 2012.
Laceration management. EBSCO DynaMed website. Available at:
http://www.ebscohost.com/dynamed/what.php
. Updated September 14, 2012. Accessed December 28, 2012.