brand logo

Am Fam Physician. 2010;81(10):1188

Author disclosure: Nothing to disclose.

Original Article: Essentials of Skin Laceration Repair

Issue Date: October 15, 2008

to the editor: Dr. Forsch neatly summarized the essentials of skin laceration repair in this article. However, he continues to promulgate the myth that local anesthetics with epinephrine should not be used in the digits. Historical reviews1 and prospective series in more than 3,000 patients2 have documented that it is safe to use lidocaine (Xylocaine) with epinephrine in the digits. In addition, phentolamine may be injected to reverse digital ischemia hours later, if necessary. Much like naloxone (formerly Narcan) is available to reverse opioid overdoses, phentolamine rescue is always possible; however, I have never needed to use it in my 10-year practice of routinely using lidocaine with epinephrine for finger surgery.3

Physicians treating lacerations in the hand or digits may easily dilute the adrenaline concentration to one half or one fourth by adding plain lidocaine. This practice enables the tissue ischemia to wear off more rapidly and still allows for optimal exposure of the wound. Plain lidocaine, without epinephrine, acts as a vasodilator and increases bleeding.

Email letter submissions to Letters should be fewer than 400 words and limited to six references, one table or figure, and three authors. Letters submitted for publication in AFP must not be submitted to any other publication. Letters may be edited to meet style and space requirements.

This series is coordinated by Kenny Lin, MD, MPH, deputy editor.

Continue Reading

More in AFP

More in PubMed

Copyright © 2010 by the American Academy of Family Physicians.

This content is owned by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may not otherwise be downloaded, copied, printed, stored, transmitted or reproduced in any medium, whether now known or later invented, except as authorized in writing by the AAFP.  See permissions for copyright questions and/or permission requests.