Contents

Search

laceration

A torn, mangled, ragged skin lesion. Complications: - diabetes, laceration size (length > 5 cm), site (trunk & extremities > head & neck), & degree of contamination are associated with wound infections [3] Management: 1) deep laceration - control of hemorrhage - management of underlying trauma - see head injury for deep lacerations of the head 2) superficial laceration - irrigation, saline or tap water; soap as needed - NO benefit in suturing hand lacerations < 2 cm in size - nonstick dressing over white petrolatum [1] - triple antibiotic ointment (Neosporin) - contact dermatitis may result from neomycin, component of Neosporin - wet dressing diminishes wound healing time - non-adherent dressing (Telfa) with plain petrolatum [1] 3) prevention of infection - routine use of antibiotics not indicated [3] - debridement of devitalized tissue - removal of foreign bodies - large-volume irrigation [3] - tetanus prophylaxis if not receive in past 5 years 4) moderately severe nonpurulent skin & soft tissue infections - target beta-hemolytic streptococci & methicillin-sensitive Staphylococcus aureus - intravenous cephalexin [1] 5) nonpurulent cellulitis associated with penetrating trauma such as gunshot or stab wounds, or injection drug use - target methicillin-resistant Staphylococcus aureus (MRSA) - intravenous vancomycin [1] 6) wound closure - most lacerations can be primarily closed - wounds should not be left open because of a delay in presentation [3] 7) absorbable sutures achieve cosmetic results & complication rates similar to those of nonabsorbable sutures in both children and adults (face, trunk & extremities) [4]

Specific

cerebral laceration diaphragm laceration hand laceration laceration of cervix

General

wound

References

  1. Medical Knowledge Self Assessment Program (MKSAP) 15, 16. American College of Physicians, Philadelphia 2009, 2012 - Medical Knowledge Self Assessment Program (MKSAP) 20 American College of Physicians, Philadelphia 2025
  2. Journal Watch 22(19):152, 2002 Suturing versus conservative management of lacerations of the hand: randomised controlled trial. Quinn J et al BMJ 325:299, 2002 PMID: 12169503
  3. Quinn JV et al. Traumatic lacerations: What are the risks for infection and has the 'golden period' of laceration care disappeared? Emerg Med J 2014 Feb; 31:96. PMID: 23314208 http://emj.bmj.com/content/31/2/96
  4. Raja AS Consider Absorbable Sutures for Lacerations of the Trunk and Extremities. Physician's First Watch, July 9 2014 David G. Fairchild, MD, MPH, Editor-in-Chief Massachusetts Medical Society http://www.jwatch.org - Tejani C et al. A comparison of cosmetic outcomes of lacerations on the extremities and trunk using absorbable versus nonabsorbable sutures. Acad Emerg Med 2014 Jul 5 PMID: 25039547 http://onlinelibrary.wiley.com/doi/10.1111/acem.12387/abstract