Laceration repair: Difference between revisions
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**Irrigate, explore, non-adherent or vaseline gauze to prevent wound edges from closing | **Irrigate, explore, non-adherent or vaseline gauze to prevent wound edges from closing | ||
**Wrap, consider oral abx | **Wrap, consider oral abx | ||
**On Day 3 remove packing, irrigate & | **On Day 3 remove packing, irrigate & suture if appears clean | ||
==Wound Preparation== | ==Wound Preparation== | ||
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==Irrigation== | ==Irrigation== | ||
*High pressure irrigation is best (can be achieved with | *High pressure irrigation is best (can be achieved with 18 gauge syringe) | ||
*Tap water is as effective as sterile water/ normal saline | *Tap water is as effective as sterile water/ normal saline | ||
*Irrigation optional for face/scalp wound as long as: | *Irrigation optional for face/scalp wound as long as: | ||
| Line 42: | Line 42: | ||
==Exploration== | ==Exploration== | ||
*Look for foreign bodies or fracture | *Look for foreign bodies or fracture | ||
*Glass in wound = xray | *Glass in wound = need for xray | ||
==Suturing== | ==Suturing== | ||
*See [[Sutures]] | |||
See [[Sutures]] | |||
==Aftercare== | ==Aftercare== | ||
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==Source== | ==Source== | ||
*UpToDate | |||
UpToDate | |||
[[Category:Trauma]] | [[Category:Trauma]] | ||
Revision as of 02:09, 28 March 2012
Indications
- Do not close body wounds >12 hr old
- Do not close face/scalp wounds >24 hr old
- If don't close, prepare wound as if going to close:
- Irrigate, explore, non-adherent or vaseline gauze to prevent wound edges from closing
- Wrap, consider oral abx
- On Day 3 remove packing, irrigate & suture if appears clean
Wound Preparation
- Debridement is most important step in reducing infection/ promoting healing
- Avoid betadine/chlorhexadine in wound
- Not necessary to remove hair (if do, avoid using razor)
Irrigation
- High pressure irrigation is best (can be achieved with 18 gauge syringe)
- Tap water is as effective as sterile water/ normal saline
- Irrigation optional for face/scalp wound as long as:
- Not a bite wound
- Not a contaminated wound
- Not older than 6 hours
Anesthesia
- NO epi if fingers, nose, toes, or penis
- Put LET in open wound, EMLA on intact skin (doesn't work in open wound)
- Check motor/sensory before give anesthesia
- Lidocaine 1% solution (10mg/mL)
- Maximum safe dose = 4mg/kg (~300mg)
- Lidocaine + epinephrine
- Maximum safe dose = 500mg
- Delays healing, increases infection risk?
- Bupivicaine (0.25%)
- Maximum safe dose = 175mg
- Do not buffer with bicarbonate
- Bupivicaine + epinephrine
- Maximum safe dose = 225mg
- To decrease pain of injection:
- Buffer lidocaine with bicarbonate (1mL bicarb:9mL lidocaine)
- Inject slowly
Exploration
- Look for foreign bodies or fracture
- Glass in wound = need for xray
Suturing
- See Sutures
Aftercare
- Splinting
- Wounds over flexor surfaces or tension
- Tetanus
- Tdap 0.5cc IM to pts >7y w/ no booster w/in 5 yr
- Hypertet 250 u IM @ diff site from Tdap if NO Hx of Td
- Require f/u Tdap @ 1mo & 1 yr; age>60 = high risk of poor immunization
- Dressing
- Keep moist, not wet
- Bandaid, xeroform, or ointment
- Keep moist, not wet
- Wound check
- 48-72 hrs ONLY if high risk wound
- No point in checking before 48hr (takes this long for infection to occur)
- 48-72 hrs ONLY if high risk wound
See Also
Source
- UpToDate