Difference between revisions of "Laceration repair"

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==Indications
+
==Indications==
 
*Do not close body wounds >12 hr old
 
*Do not close body wounds >12 hr old
 
*Do not close face/scalp wounds >24 hr old
 
*Do not close face/scalp wounds >24 hr old

Revision as of 07:46, 5 April 2011

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

  • 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
  • Bupivicaine + epinephrine
    • Maximum safe dose = 225mg
  • To decrease pain of injection:
    • Buffer lidocaine with bicarbonate (1mL bicarb:9mL lidocaine)

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