Laceration repair

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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: 10mL 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
  • High pressure irrigation (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

Trauma: Wound Management

Trauma: Sutures


Source

UpToDate