Basic Laceration Repair

Abstract

INDICATIONS Lacerations are among the most common reasons for visits to emergency departments, with over 11 million wounds treated each year in the United States. 1 Although most lacerations will heal without treatment, repair of these injuries reduces infection, scarring, and patient discomfort. 2 Various methods may be used for laceration repair. Suturing is the most common method of wound closure and is demonstrated in the accompanying video and discussed in detail here. Wound staples, frequently used on lacerations involving the scalp, torso, arms, legs, hands, and feet, offer the advantage of rapid placement but do not allow for the meticulous wound-edge approximation afforded by suturing. Tissue adhesives, such as 2-octylcyanoacrylate, are less painful and more quickly applied than sutures or staples and are ideal for small lacerations that are not subject to large degrees of tension. 2 Tissue tapes (e.g., Steri-Strips, 3M) may be used for superficial or partial-thickness lacerations but are not suitable for lacerations that are subject to considerable tension. CONTRAINDICATIONS Not all lacerations are suitable for primary closure. Some should be allowed to heal by secondary intention (i.e., granulation and reepithelialization) or should, in specific cases, be repaired 3 to 5 days after injury (delayed primary, or tertiary, closure). The decision to suture a wound must be made on an individual basis and take numerous factors into consideration. The interval between injury and evaluation is important, since delays in repair may increase the risk of infection. The location of the wound and the degree of contamination may affect the acceptable interval between injury and repair. For example, some contaminated wounds on the hands or feet may require closure within 6 hours, whereas some facial or scalp lacerations can often be safely repaired more than 24 hours after injury. The decision to suture a wound must be made on an individual basis, and the interval between injury and repair may be shortened for patients with impaired host defenses. 3 Secondary closure should be strongly considered for wounds that are grossly contaminated and for most puncture and bite wounds to the extremities. Delayed primary closure may be used for large or cosmetically important lacerations that are not suitable for primary repair. 1 After 3 to 5 days, the patient’s natural defenses reduce the bacterial load, thereby reducing the risk of infection. 3