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A laceration is an injury that results in opening of the skin
and deeper structures. The wound may be jagged, dirty, or bleeding. After
applying pressure to stop bleeding, the area should be cleaned with soap
and water. If the bleeding stops easily, and the cut is superficial (less
than 1-2 inches long and not deep enough to leave the skin gaping open),
pour hydrogen peroxide over the area to foam away any remaining dirt,
apply antibiotic ointment (such as Neosporin, Polysporin, or Bacitracin)
and a bandage. Watch for signs of infection—redness, increasing
tenderness, swelling, and drainage of pus--over the next several days.
Call the office to have your child seen if this happens.
How
do you know if a laceration needs to be repaired by the doctor? ·
Is the wound still
bleeding after applying pressure for 10 to 15 minutes? ·
Is the wound full of
dirt or other debris? ·
Is the skin gaping
open, jagged, or exposing deeper tissue such as fat, muscle, tendons, or bone? ·
Could there be a broken
bone inside the wound? All
of these lacerations need medical attention within 8 hours of
the injury to minimize the risk of infection. The purpose of laceration repair
is to stop bleeding, prevent infection, restore function of the tissues, and
minimize scarring and loss of appearance.
The
doctor must assess the severity of the wound to decide how to proceed.
Anesthesia of the wound for the repair is essential. Some patients will
require x-ray evaluation for foreign body or a broken bone. Others may require
a surgeon to repair muscles, nerves, or tendons that are torn. Irrigation of a
deep wound for dirt or glass, or cutting away damaged tissues (debridement) to
preserve the integrity of the area may be needed. Deeper lacerations
frequently require closure in layers, using absorbable sutures. Facial
lacerations may require a plastic surgeon to repair to minimize scarring. For
all these reasons, we may refer patients to the emergency room or to a surgeon
for their repair. Simple
linear lacerations can be closed with steri-strips, dermabond adhesive, or
stitches. The type of laceration, its location, and the age of the child may
contribute to the choice of closure. All lacerations leave some scar, and how
large or small they are will be affected by cleaning of the wound, infection,
type of closure, and the nature of that individual’s skin type.
After a laceration is repaired, it should be kept clean and dry for the next 24-48 hours. After that time, follow the doctor’s recommendation to clean the area and watch for any signs of infection. The doctor will advise you on when the stitches should be removed, as this depends on the type and location of the laceration. Check the records for the date of the last tetanus vaccine for any dirty wound. Always be alert to the potential for infection, and return to the office if there is concern.
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