Laceration repair

Revision as of 02:09, 28 March 2012 by Jswartz (talk | contribs)

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

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
  • Wound check
    • 48-72 hrs ONLY if high risk wound
      • No point in checking before 48hr (takes this long for infection to occur)

See Also

Source

  • UpToDate