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10.01 Simple laceration


Presentation

There may be a history of being slashed by a knife, glass shard or other sharp object that results in a clean, straight wound. Impact with a hard object at an angle to the skin may tear up a flap of skin. Crush injury from a direct blow may produce an irregular or stellate laceration with a variable degree of devitalized tissue, abrasion and visible contamination. Wounds may involve vascular areas of the face and scalp where the risk of infection is low, or extremities where infection becomes a greater risk, along with the possibility of tendon and nerve damage. The elderly and patients on chronic steroid therapy may present with "wet tissue paper" skin tears following relatively minor trauma.

What to do:

What not to do:

Discussion

The most important goal of early wound care is preventing infection. Ointments probably facilitate healing and reduce infection by their occlusive rather than antibiotic properties. Extensive primary excision limits options for later scar revision, and sometimes it reasonable to close a contaminated facial laceration for cosmetic reasons, but this is the exception that proves the rule.

Although not yet available in the US outside of veterinary practice, butyl cyanoacrylate (Histoacryl blue) the less toxic version of SuperGlue, works well for minor pediatric lacerations. The technique is to hold edges together (the same as for tape or staples), drip one drop onto the gap every centimeter, and hold for ten seconds.

References:


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from Buttaravoli & Stair: COMMON SIMPLE EMERGENCIES
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Craig Feied, MD
Mark Smith, MD
Jon Handler, MD
Michael Gillam, MD