Your Health - Laceration Repair

Laceration Repair

(Wound Repair)

Pronounced: Lass-er-ae-shun repair

Definition

A laceration is a wound that occurs when skin, tissue, and/or muscle is torn or cut open. Lacerations may be deep or shallow, long or short, and wide or narrow. Laceration repair is the act of cleaning, preparing, and closing the wound.

Laceration Wound of the Hand

Reasons for Procedure

Minor lacerations (shallow, small, not bleeding, and clean) may not require medical attention. Antibiotic ointment and a bandage may be all that is needed. Some lacerations do require repair. Reasons for seeking medical attention include:

Muscle, fat, tendon, or bone is exposed
Dirt and debris can be seen in the wound or remains after irrigation and cleaning
You do not see any debris but feel as if something is in the wound
Wound is at risk for developing tetanus: deep, associated with a crush injury or burn, contaminated with feces, dirt, or saliva
You have never received a total of at least 3 doses of tetanus immunization (routine childhood immunizations gives a dose at ages 2, 4, 6, and 15-18 months), or if it has been more than 5 years since your last tetanus immunization, or you are unsure of your tetanus status
Manifestations of tetanus develop 3-21 days after wound occurred: spasm or rigidity of muscles in jaw, neck, abdomen, or an area near the wound
Bleeding continues after applying direct pressure for 10-15 minutes
Edges of the wound are jagged or uneven
Wound is more than 1/8 to 1/4 inch deep, or located over a joint and possibly extents into the joint-space (knee, knuckle, wrist, ankle)
Edges of the wound cannot easily be moved together or aligned
Wound is located at an area of high stress (joints, hands, feet, chest)
Decrease risk of unsightly scarring

Note: If you are not sure if a wound needs to be repaired, go to the hospital.

Possible Complications

If you have a laceration repair, your doctor will review a list of possible complications which may include:

Infection
Bleeding
Noticeable scarring
Poor wound closure
Allergic reaction to anesthetic

What to Expect

Prior to Procedure

Before you are seeing the doctor, to treat the laceration:

Apply direct pressure to the wound with gauze, a clean cloth, plastic bags, or, as a last resort, with a clean hand. If the wound bleeds through the gauze or cloth, do not remove it. Add more gauze.
If possible, elevate the wound above the heart. This will make it harder for blood to flow to the wound. Do not tie a tourniquet around an affected limb. This may cause more damage to the wound.
If bleeding stops, irrigate/shower wound directly with tap water.
If muscle, tendon, bone, or organs are exposed, do not try to push them back into place.
If feeling faint, lie down or sit with your head between your knees.

Once you are at the hospital, the doctor will likely do the following:

Examine the wound
Decide if a surgeon is needed
Ask about your medical history, allergies, and how the wound occurred
Discuss your pain tolerance and preferred method of wound closure
Explain the procedure

Anesthesia

This depends on the type of laceration, for example:

Local anesthesia—just the area that is being operated on is numbed; given as an injection; used for minor lacerations
General anesthesia—blocks pain and keeps you asleep through the surgery; used for severe lacerations

In some cases, no anesthesia is given.

Description of Procedure

The wound will be cleaned and prepared:

Cleaning
- Hair that will interfere with wound closure and healing will be trimmed or smoothed flat.
- Sterile water will squirted in the wound. This will wash away dirt and debris.
- Antiseptic or mild soap may also be used if the wound is deep and dirty.
Preparing
- Jagged edges may be cut away. This will allow the wound to heal with a less noticeable scar.
- Damaged or dead tissue will be removed to prevent infection.
Closing
- This will be done once the wound is sterile and dry.
- The doctor will choose one of several ways to close the wound:
  - Dermabond
  - Steristrips
  - Sutures
  - Staples
  - Hair tying

Dermabond

Dermabond is a special glue that holds a wound together. Dermabond is used on the face, arms, legs, and torso. It can also be used on lacerations smaller than 2-½ inches. It is not used for lips, lacerations that are over joints, deep lacerations, or most hand and foot lacerations. The doctor will hold the wound shut. Next, he will apply a thin layer of Dermabond. Warmth may be felt as the glue sets. Dermabond will be applied in three coats. The wound will then be held in place for 60 seconds. The doctor may place a bandage over the wound. In some cases, stitches may also be done.

Note: The glue acts like a protective coat. It is not placed in the wound, or in between the edges of the wound. Never try to repair a wound at home with glue. Getting glue into wounds may prevent the wound from healing properly.

Steristrips

These adhesive strips are used for minor lacerations that are:

Clean
Have relatively straight edges that match up
Are easy to push closed

The doctor will align the wound. The strips will be applied across the wound.

Sutures

Sutures are used for wounds that are deep, bleeding, have jagged edges, or have fat or muscle exposed. The area will be cleaned with iodine and a surgical drape may be positioned over the wound and taped to the skin. This will be done to keep the area sterile.

If a laceration is deep and underlying tissue or muscle is also lacerated, stitches may be needed under the skin before the wound can be closed. This will rejoin muscle and tissue layers. The stitches used under the skin will be absorbed by the body. So, they will not need to be removed.

If a wound is not deep, or the suturing under the skin is finished, the wound will be stitched shut. Once the wound is closed, saline will be used to clean the area. A thin layer of antiseptic ointment may be applied, as well. A gauze pad may be placed over the stitches. Also, an elastic bandage or tape may be used to cover and protect.

Staples

Staples are best suited for the scalp, neck, arms, legs, torso, and buttocks. Iodine will be applied to the skin surrounding the wound. The wound edges will be closed and aligned. Staples will be placed along the wound.

The doctor will use saline to cleanse the staple line. The area will be patted dry. An antibiotic ointment will be applied. Next, the doctor will apply a clear acrylic dressing called Tegaderm to the staple line. Then, a gauze pad and tape will be used to secure the wound.

Hair Tying

Hair tying is used for some scalp lacerations. Hair will be gathered in a way that pulls the wound shut. The hair will then be rubber banded or held together with dermabond so the wound remains shut. This technique follows the same principal as stitches without having to penetrate the skin.

How Long Will It Take?

This depends on the laceration. It may take less than 15 minutes or more than an hour.

How Much Will It Hurt?

This also depends on the laceration. Severe lacerations will be very painful. Ask your doctor about pain medicine.

Post-procedure Care

At the Care Center

Following the procedure, the staff may provide the following care to make you more comfortable and help your recovery:

Give you pain medicine and antibiotics.
Have blood tests done. This is done most often for dirty or bite-inflicted lacerations.
Give you a tetanus booster.

At Home

When you return home, do the following to help ensure a smooth recovery:

Be sure to follow your doctor's instructions, such as:
- Avoid strenuous activities.
- Take antibiotics and pain medications as directed.
If you received stitches or staples, ask your doctor when you can take a bath. You may be able to after 24 hours. If you had Dermabond or hair tying, you may be able to shower.
If you need to keep the incision area dry when showering, wrap the area with a plastic bag.
After showering or bathing, pat the area dry. Do not rub the area. Also, do not apply hydrogen peroxide or iodine to the wound. This will damage tissue and slow healing.

Removal of wound closure material depends on the type of repair that you had:

Dermabond will fall off by itself in 5-10 days.
Steristrips will typically be removed after 5-10 days. Or, they will fall off on their own.
Stitches will be removed after 5-14 days.
Staples will be removed after 5-10 days.
Rubber bands will be cut from hair in 7-10 days.

Note: Do not try to remove the closure material. Removing materials yourself may lead to infection, scarring, or reopening of the wound.

All lacerations heal with scars. The degree of scarring varies and is influenced by:

A personal history of excessive scar (keloids) formation
Location, type, and size of the wound
Skill of the doctor

Picking at a wound, scratching, infection, and participating in restricted activity may lead to poor healing. If a noticeable scar does result, plastic surgery may be used to decrease the scar’s appearance.

Call Your Doctor

After arriving home, contact your doctor if any of the following occurs:

Wound reopens
Redness, warmth, swelling, drainage or excessive bleeding occurs at the wound site.
Signs of infection including fever, chills, or red streaks tracking up arm or leg
Any other concerns

In case of an emergency, call 911.

RESOURCES:

American Academy of Family Physicians
http://www.aafp.org/

National Library of Medicine
http://www.nlm.nih.gov/

CANADIAN RESOURCES:

Canadian Association of Wound Care
http://www.cawc.net/open/wcc/index.html/

Skin Care Guide.ca
http://www.skincareguide.ca/

References:

Beam, J. W. Wound Cleansing: Water or Saline? J Athl Train. 2006;4(2):196-197.

Burns T, Worthington J. Using tissue adhesive for wound repair: a practical guide to Dermabond. American Academy of Family Physicians website. Available at: http://www.aafp.org/afp/20000301/1383.html . Published March 1, 2000. Accessed September 15, 2005.

Cuts and scrapes. Mayo Clinic website. Available at: http://www.mayoclinic.com/invoke.cfm?objectid=FDEFD23A-F29F-47FB-9A7CD4CF4427D590. Updated June 2009. Accessed September 18, 2009.

Joyce, M. P. Routine Vaccine-Preventable Diseases - Tetanus. Centers for Disease Control and Prevention website. Available at: http://wwwnc.cdc.gov/travel/yellowbook/2010/chapter-2/tetanus.aspx. Updated July 27, 2009. Accessed October 30, 2009.

Laceration. Allina Hospitals and Clinic website. Available at: http://www.medformation.com/ac/mm_qdis.nsf/qd/nd0730g.htm . Accessed September 15, 2005.

Ong, M. E. A randomized controlled trial comparing the hair apposition technique with tissue glue to standard suturing in scalp lacerations (HAT study). Ann Emerg Med. 2002;40:19-26.

Perron AD, et al. The efficacy of cyanoacrylate-derived surgical adhesive for use in the repair of lacerations during competitive athletics. Am J Emerg Med . 2000; 18:261-263.

Quinn J, et al. Tissue adhesive versus suture wound repair at 1 year: randomized clinical trial correlating early, 3-month, and 1-year cosmetic outcome. Ann Emerg Med . 1998; 32:645-649.

Snell G. Laceration Repair: Procedures for Primary Care Physicians . St. Louis, MO: Mosby; 1994.

Wilson J, Kocurek K, Doty J. A systematic approach to laceration repair: tricks to ensure the desired cosmetic results. Postgraduate Medicine Online website. Available at: http://www.postgradmed.com/issues/2000/04_00/wilson.htm . Accessed September 15, 2005.

Last reviewed November 2009 by D. Steele Beasley, MD

Please be aware that this information is provided to supplement the care provided by your physician. It is neither intended nor implied to be a substitute for professional medical advice. CALL YOUR HEALTHCARE PROVIDER IMMEDIATELY IF YOU THINK YOU MAY HAVE A MEDICAL EMERGENCY. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with any questions you may have regarding a medical condition.