Laceration Repair: A Practical Approach

 

Am Fam Physician. 2017 May 15;95(10):628-636.

  Patient information: See related handout on taking care of healing cuts.

Author disclosure: No relevant financial affiliation.

The goals of laceration repair are to achieve hemostasis and optimal cosmetic results without increasing the risk of infection. Many aspects of laceration repair have not changed over the years, but there is evidence to support some updates to standard management. Studies have been unable to define a “golden period” for which a wound can safely be repaired without increasing risk of infection. Depending on the type of wound, it may be reasonable to close even 18 or more hours after injury. The use of nonsterile gloves during laceration repair does not increase the risk of wound infection compared with sterile gloves. Irrigation with potable tap water rather than sterile saline also does not increase the risk of wound infection. Good evidence suggests that local anesthetic with epinephrine in a concentration of up to 1:100,000 is safe for use on digits. Local anesthetic with epinephrine in a concentration of 1:200,000 is safe for use on the nose and ears. Tissue adhesives and wound adhesive strips can be used effectively in low-tension skin areas. Wounds heal faster in a moist environment and therefore occlusive and semiocclusive dressings should be considered when available. Tetanus prophylaxis should be provided if indicated. Timing of suture removal depends on location and is based on expert opinion and experience.

Approximately 6 million patients present to emergency departments for laceration treatment every year.1 Although many patients seek care at emergency departments or urgent care centers, primary care physicians are an important resource for urgent laceration treatment. Many aspects of laceration repair have not changed, but there is evidence to support some updates to standard management.

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SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferences

Noninfected wounds caused by clean objects may undergo primary closure up to 18 hours after injury. Head wounds may be repaired up to 24 hours after injury.

B

2, 79

Using potable tap water instead of sterile saline for wound irrigation does not increase the risk of infection.

A

2, 1012

Use of clean nonsterile examination gloves rather than sterile gloves during wound repair does not significantly increase risk of infection.

A

11, 1820

If there is no concern for vascular compromise to an appendage, local anesthetic containing epinephrine in a concentration of up to 1:100,000 is safe for use in laceration repair of the digits, including for digital blockade.

B

29, 30


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to http://www.aafp.org/afpsort.

SORT: KEY RECOMMENDATIONS FOR PRACTICE

Clinical recommendationEvidence ratingReferences

Noninfected wounds caused by clean objects may undergo primary closure up to 18 hours after injury. Head wounds may be repaired up to 24 hours after injury.

B

2, 79

Using potable tap water instead of sterile saline for wound irrigation does not increase the risk of infection.

A

2, 1012

Use of clean nonsterile examination gloves rather than sterile gloves during wound repair does not significantly increase risk of infection.

A

11, 1820

If there is no concern for vascular compromise to an appendage, local anesthetic containing epinephrine in a concentration of up to 1:100,000 is safe for use in laceration repair of the digits, including for digital blockade.

B

29, 30


A = consistent, good-quality patient-oriented evidence; B = inconsistent or limited-quality patient-oriented evidence; C = consensus, disease-oriented evidence, usual practice, expert opinion, or case series. For information about the SORT evidence rating system, go to http://www.aafp.org/afpsort.

Approach to the Wound

The goals of laceration repair are to achieve hemostasis and optimal cosmetic results without increasing the risk of infection. Important considerations include timing of the repair, wound irrigation techniques, providing a clean field for repair to minimize contamination, and appropriate use of anesthesia. An article on wound care was previously published in American Family Physician.2

EVALUATING THE WOUND

When a patient presents with a laceration, the physician should obtain a history, including tetanus vaccination status, allergies, and time and mechanism of injury, and then assess wound size, shape, and location.3 If active bleeding persists after application of direct pressure, hemostasis should be obtained using hemostat, ligation, or sutures before further evaluation. Hemostasis controls bleeding, prevents hematoma formation, and allows for deeper inspection of the wound.3 The next step is to determine whether vessels, tendons, nerves, joints,

The Authors

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RANDALL T. FORSCH, MD, MPH, is an assistant professor in the Department of Family Medicine at the University of Michigan Medical School in Ann Arbor....

SAHOKO H. LITTLE, MD, PhD, is an assistant professor in the Department of Family Medicine at the University of Michigan Medical School. She is also an attending physician at the Comprehensive Wound Care Clinic, University of Michigan.

CHRISTA WILLIAMS, MD, is a clinical lecturer in the Department of Family Medicine at the University of Michigan Medical School.

Address correspondence to Randall T. Forsch, MD, MPH, University of Michigan Medical School, 1301 Catherine, Ann Arbor, MI 48109-5624 (e-mail: rforsch@umich.edu). Reprints are not available from the authors.

Author disclosure: No relevant financial affiliation.

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