Laceration Repair

Summary: <br> Step 1: Pain Control<br> <br> <br> <br> * Local anesthesia* Most common agent is lidocaine (frequently already in laceration repair kits)* Inject through wound edges (not through epidermis)* This decreases pain* Alternative is digital/regional nerve block<br> <br> <br> <br> Step 2: Irrigation<br> <br> <br> <br> * Laceration repair is not a sterile procedure* Copious irrigation is the best method to decrease chance of wound infection* Faucet/sink vs saline<br> <br> <br> <br> Step 3: Alternative Wound Closure Techniques<br> <br> <br> <br> * Dermabond/Tissue Adhesive* Works best on easily approximated wound edges and little tension* Commonly used in pediatrics and geriatrics* Staples* Sometimes leaves a poor cosmetic outcome* Commonly used for scalp wounds* Rapidly stops bleeding* Quickest and easiest closure method to perform<br> <br> <br> <br> Step 4: Choose a Suture Type<br> <br> <br> <br> * Absorbable (Gut, Monocryl) * Pros: Patient doesn’t need to return for removal* Cons: Loses tensile strength* Non-Absorbable (Prolene)* Pros: Good cosmetic outcomes, easy to see (bright blue)* Cons: Patient must have them removed<br> <br> <br> <br> Step 5: Repair the Wound<br> <br> <br> <br> * Gently approximate wound edges* You are not trying to “seal” the wound closed* Primary goal is to improve cosmetic outcome* Keep it simple* Simple interrupted sutures* Instrument tie<br> <br> <br> <br> Additional Reading<br> <br> <br> <br> * Laceration Evaluation <a href="http://www.emclerkship.com/laceration-evaluation/">(EM Clerkship)</a>* Wound Closure for the Emergency Practitioner <a href="https://lacerationrepair.com">(LacerationRepair)</a><br>