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• Evert wound edges for better aesthetic outcomes.

• Wound irrigation and debridement prevent wound

infections.

use 6-12 hours as a guideline for closing these wounds.

Lacerations sustained by a blunt, crushing force produce

more local tissue damage and therefore have a higher rate

of infection than lacerations caused by a sharp instrument

(ie, knife). A puncture wound also has a high rate of infection because bacteria are driven into the tissue and are

difficult to remove. Visible contamination within a wound

doubles the likelihood of infection. Bite wounds ( eg, dog,

cat, human) have a very high rate of infection owing to

bacterial colonization within the mouth. Generally, bite

wounds are not closed primarily unless the wound is gaping or in a cosmetically sensitive area (eg, face).

Staples and tissue adhesive should not be used on deep

wounds that would require multiple layered closure. Tissue

adhesives should not be used near mucosal surfaces, within

the scalp, or over joints (without immobilization), and care

must be taken when used near the eyes.

EQUIPMENT

When preparing the wound for closure, the following are

needed: povidone-iodine solution, local anesthetic ( 1 o/o

lidocaine with or without 1:100,000 epinephrine), 25- or

27-gauge needle, and a syringe. Irrigation is typically performed with normal saline or sterile water, a 60-mL

syringe, and an irrigation shield or 18-gauge angiocatheter;

however, some authors have argued that tap water is s uffi.­

cient for uncomplicated wounds. Similarly, sterile gloves

are typically used, although one study did not show

LACERATION REPAIR

Figure 6-1. Suture instruments. From left to right:

need le driver, tissue forceps (pick-ups), and scissors.

a decreased infection rate when sterile gloves were used

compared with clean gloves in the repair of clean wounds

less than 6 hours old. Instruments needed include a needle

driver, tissue forceps (pick-ups), and scissors (Figure 6-1).

Use the smallest monofilament suture available that will

adequately appose the ends of the laceration, because thinner suture causes less scarring. Usually 4-0 (largest, for

torso and extremities) to 6-0 (smallest, for face) will suffice. Antibacterial ointment, gauze, and tape are needed for

aftercare.