Minor injuries: laceration repairs

Correspondence to I Colmers-Gray [email protected]

What you need to know

• Consider the type of injury (laceration, puncture, crush, abrasion), anatomical location, and patient characteristics when planning an approach to wound repair

• Manage precipitating factors that led to the injury (eg, syncope)

• All lacerations require irrigation prior to closure and consideration of tetanus prophylaxis, but only certain patients and laceration types require antibiotic prophylaxis

Lacerations are a common presentation in urgent and emergency care settings. In this article we discuss a basic approach to wound management, when to provide antibiotic prophylaxis, and when to involve a specialist. Readers may have varied training, experience, and practice setting(s); therefore we recommend referring to local expertise, resources, and protocols when appropriate.

Initial assessment

When assessing a patient with a laceration, consider the following:

• Elicit when and how the injury occurred and manage precipitants, such as a syncope, self-harm, or substance use.

• Assess for additional injuries, paying special attention to areas not immediately visible, such as the axillas, scalp, and back.

• For upper limb injuries, determine hand dominance, occupation, and important recreational activities (eg, sports, playing musical instruments).

• Conduct a neurovascular examination for pulses, capillary refill, sensation, and motor function—especially for hand, foot, and facial injuries.

• Where appropriate, request imaging to rule out underlying fractures or foreign bodies.

• Consider taking medical photographs (document consent), or photographs on the patient’s mobile device, to track wound progression.

• Note factors that may impair healing or increase infection, including peripheral vascular disease, diabetes, heavy alcohol use, smoking, steroids, immunodeficient states, extremes of age, or malnutrition.

• Ask about tetanus vaccination status and antiplatelet/anticoagulant medications. Offer tetanus prophylaxis per regional guidelines.¹²³

Management

If the wound is actively bleeding

Apply gauze and pressure over the wound. Most arterial bleeding stops with continuous direct digital pressure for at least 5-10 minutes (don’t be tempted to check before that time has elapsed). If bleeding continues, some wounds are amenable to injection with an epinephrine-containing anaesthetic or application of a gauze soaked in tranexamic acid. If bleeding has not slowed after 15 minutes, refer to surgery urgently.

To gain rapid haemostatic control of brisk, persistent bleeds, temporarily close the skin with a continuous stitch, such as a whipstitch or baseball stitch (providing circumferential pressure to opposing skin...