laceration

^[1]^[2]^[3]^[4]

Introduction

A torn, mangled, ragged skin lesion.

diabetes, laceration size (length > 5 cm), site (trunk & extremities > head & neck), & degree of contamination are associated with wound infections^[3]

deep laceration
- control of hemorrhage
- management of underlying trauma
- see head injury for deep lacerations of the head
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]
prevention of infection
- routine use of antibiotics not indicated^[3]
- debridement of devitalized tissue
- removal of foreign bodies
- large-volume irrigation^[3]
wound closure
- most lacerations can be primarily closed
- wounds should not be left open because of a delay in presentation^[3]
absorbable sutures achieve cosmetic results & complication rates similar to those of nonabsorbable sutures in both children and adults (face, trunk & extremities)^[4]

↑ ^1.0 ^1.1 ^1.2 Medical Knowledge Self Assessment Program (MKSAP) 15, 16. American College of Physicians, Philadelphia 2009, 2012
↑ 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: https://www.ncbi.nlm.nih.gov/pubmed/12169503
↑ ^3.0 ^3.1 ^3.2 ^3.3 ^3.4 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. <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/23314208 <Internet> http://emj.bmj.com/content/31/2/96
↑ ^4.0 ^4.1 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 <PubMed> PMID: https://www.ncbi.nlm.nih.gov/pubmed/25039547 <Internet> http://onlinelibrary.wiley.com/doi/10.1111/acem.12387/abstract