Laceration repair

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 & sew if appears clean

Anesthesia

• NO epi if fingers, nose, toes, or penis
• Lidocaine (1% solution (10mg/mL)
  • Maximum safe dose = 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

Skin Preparation

• Avoid betadine/chlorhexadine in wound
• Not necessary to remove hair (if do, avoid using razor)

Wound Preparation

• Debridement is most important step in reducing infection/ promoting healing
• Irrigation
  • High pressure irrigation is best (can be achieved with 19 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

See Also

Wound Management

Sutures

Source

UpToDate