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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