A laceration is a traumatic break in the skin caused by a sharp object producing edges that may be jagged, dirty, or bleeding. The underlying tissue may also be severed. In such instances, the physician may place absorbable sutures in the tissue to help bring the edges together before the skin is sutured close. (Illustration by Electronic Illustrators Group.)

  Definition

A laceration is a wound caused by a sharp object producing edges that may be jagged, dirty, or bleeding. Lacerations most often affect the skin, but any tissue may be lacerated, including subcutaneous fat, tendon, muscle, or bone.

  Purpose

A laceration should be repaired if it:

• Continues to bleed after application of pressure for ten to fifteen minutes
• Is more than one-eighth to one-fourth inch deep
• Exposes fat, muscle, tendon, or bone
• Causes a change in function surrounding the area of the laceration
• Is dirty or has visible debris in it
• Is located in an area where an unsightly scar is undesirable.

  Precautions

Lacerations are less likely to become infected if they are repaired soon after they occur. Many physicians will not repair a laceration that is more than eight hours old because the risk of infection is too great.

  Description

Laceration repair mends a tear in the skin or other tissue. The procedure is similar to repairing a tear in clothing. Primary care physicians, emergency room physicians, and surgeons usually repair lacerations. The four goals of laceration repair are to stop bleeding, prevent infection, preserve function, and restore appearance. Insurance companies do pay for the procedure. Cost depends upon the severity and size of the laceration.

Before repairing the laceration, the physician thoroughly examines the wound and the underlying tendons or nerves. If nerves or tendons have been injured, a surgeon may be needed to complete the repair. The laceration is cleaned by removing any foreign material or debris. Removing foreign objects from penetrating wounds can sometimes cause bleeding, so this type of wound must be cleaned very carefully. The wound is then irrigated with saline solution and a disinfectant. The disinfecting agent may be mild soap or a commercial preparation. An antibacterial agent may be applied.

Once the wound has been cleansed, the physician anesthetizes the area of the repair by injecting a local anesthetic. The physician may trim edges that are jagged or extremely uneven. Tissue that is too damaged to heal must be removed (debridement) to prevent infection. If the laceration is deep, several absorbable stitches (sutures) are placed in the tissue under the skin to help bring the tissue layers together. Suturing also helps eliminate any pockets where tissue fluid or blood can accumulate. The skin wound is closed with sutures. Suture material used on the surface of a wound is usually non-absorbable and will have to be removed later. A light dressing or an adhesive bandage is applied for 24-48 hours. In areas where a dressing is not feasible, an antibiotic ointment can be applied. If the laceration is the result of a human or animal bite, if it is very dirty, or if the patient has a medical condition that alters wound healing, oral antibiotics may be prescribed.

  Aftercare

The laceration is kept clean and dry for at least 24 hours after the repair. Light bathing is generally permitted after 24 hours if the wound is not soaked. The physician will provide directions for any special wound care. Sutures are removed 3-14 days after the repair is completed. Timing of suture removal depends on the location of the laceration and physician preference.

The repair should be observed frequently for signs of infection, which include redness, swelling, tenderness, drainage from the wound, red streaks in the skin surrounding the repair, chills, or fever. If any of these occur, the physician should be contacted immediately.

  Risks

The most common complication of any laceration repair is infection. Risk of infection can be minimized by cleansing the wound thoroughly. Wounds from bites or dirty objects or wounds that have a large amount of dirt in them are most likely to become infected.

All lacerations will heal with a scar. Wounds that are repaired with sutures are less likely to develop scars that are unsightly, but no one can predict how wounds will heal and who will develop unsightly scars. Plastic surgery can improve the appearance of many scars.

   Key Terms:

Debridement The act of removing any foreign material and damaged or contaminated tissue from a wound to expose surrounding healthy tissue.

   Resources:

Books

• Snell, George."Laceration Repair." In Procedures for Primary Care Physicians, ed. John L. Pfenninger and Grant C. Fowler. St. Louis: Mosby, 1994.

Other

• "Caring for Cuts and Scrapes at Home." Mayo Clinic Online. http://www.mayohealth.org/mayo/9611/htm/cuts_sb.htm
• "Cuts and Scrapes." Mayo Clinic Online. 5 Mar. 1998 http://www.mayohealth.org
• "Laceration Repair." ThriveOnline. http://thriveonline.oxygen.com