March 2017 – EM Clerkship, LLC

Step 1: Pain Control

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

Step 2: Irrigation

Laceration repair is not a sterile procedure
Copious irrigation is the best method to decrease chance of wound infection
- Faucet/sink vs saline

Step 3: Alternative Wound Closure Techniques

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

Step 4: Choose a Suture Type

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

Step 5: Repair the Wound

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

Additional Reading

To Close or Not To Close?

Closing a wound with sutures, etc = Healing by “primary intention”
- INCREASES risk of infection but DECREASES scar
Leaving a wound open = Healing by “secondary intention”
- DECREASES risk of infection but INCREASES scar

Step 1: History

Step 2: Identify Tetanus Status

Step 3: Tetanus Prophylaxis

Step 4: Give Specific, Objective Description of Laceration

Step 5: Rule Out Foreign Body

Consider X-Ray
- Not all foreign bodies will show up on x-ray
  - Especially organic material, clothing, etc
Consider bedside ultrasound
- (You are not expected to know how to do this, only to consider this)

Additional Reading

Month: March 2017