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] 4) wound closure - most lacerations can be primarily closed - wounds should not be left open because of a delay in presentation [3] 5) 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
  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