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Lacerations

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US Army First Aid Manual
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Appendix A: First Aid Case and Kits, Dressings, and Bandages
Appendix B: Rescue and Transportation Procedures
Appendix C: Common Problems/Conditions
Appendix D: Digital Pressure
Appendix E: Decontamination Procedures
Appendix F: Glossary


Lacerations Overview

by: Todd H. Chaffin, M.D.

As a physician, I am often asked what wounds need to sewn or surgically repaired. The reality is that few wounds "need to be repaired" because a body's healing potential is tremendous. Most wounds if not contaminated or harboring a foreign body, as long as they don't get infected, will eventually heal given enough time and local treatment. The problem is, certain wounds are best treated with some type of surgical closure in order to afford the best healing potential. What this means is that the sooner a wound is repaired, the better is the cosmetic result, i.e. less scaring. An example would be a 2" superficial cut on the thigh would heal satisfactorily, as would a ½" laceration on your face. The laceration on your face, however, being of cosmetic importance, will most often best be treated with some type of prompt surgical closure. The faster a wound heals, the less scarring and less chance for infection

What should I do if medical help is not readily available? The most important wound care principle is wound irrigation. "The solution to pollution is dilution" is a commonly sited medical axiom. Whether a wound is ever surgically repaired or not, the most important thing is to irrigate the wound with copious amounts of sterile saline and if unavailable, tap water. This dilutes any bacterial contamination and removes any particulate matter that can increase a wound's potential for infection. The next most important principle is to remove any foreign material or foreign bodies as best as possible. Following this, approximating the wound edges (with tape or bandage) facilitates re-epithelialization (the body's natural tendency to contract and seal over a wound). The best cosmetic outcome and least amount of scarring will occur. This process takes place best in a moist (not wet) environment. If you have antibiotic ointment, it can be provided in a thin film over the wound that will allow the wound to retain moisture. If this is unavailable, a sterile saline, moistened gauze applied over the wound is acceptable. Sterile gauze and wrap are then applied. Leaving the wound "open to dry" allows for scab formation and crusting to develop and may make for a worse cosmetic appearance. The wound should be covered in this fashion until adequate healing has occurred, which may be anywhere from 1-2 weeks, depending on the location. Wounds involving the head, face and upper extremity tend to heal more rapidly then wounds further from the heart. The better the blood flow, the quicker wounds tend to heal. Wounds on the feet and legs tend to heal the slowest for this reason.

When should I seek medical attention for a wound? Generally, if the wound is more than ½" long, is gaping open, is dirty, retains a possible foreign body, or is cosmetically important to repair surgically, or if there is a potentially deep penetration (such as a knife stab wound). Also, or if there is any perceived function loss such as motion, circulation or sensation, then these should be evaluated by medical personnel as promptly as possible.

What do I do if I can't get to a medical facility? As outlined above, the wound should be irrigated and a dressing applied. In the past it was thought that there was a "golden period" ranging up to 12-24 hours after which a wound should not be surgically closed. This has been refuted by several large studies. Most wounds, even days old, can be surgically repaired as long as they are not infected. It is always best to have wounds evaluated by trained medical personnel if there is any doubt in one's mind as to whether the wound can be managed by local first aid measures, or requires greater medical expertise. The above recommendations are made only to assist those who do not have readily accessible medical care.

Treating Lacerations

by: Dan Williams, Psy. D., PA-C

Outdoor treatment
Many individuals who hunt, fish, camp and hike eventually sustain a laceration. This article will address specifically what to do in the outdoors scenario.

  1. Irrigate, irrigate, irrigate. Most individuals will not have a syringe to push fluid through the wound. A plastic bag will work wonders. Fill your plastic bag with water and punch a tiny hole on the end. Squeeze the end like using a cake decorating bag. You now have a pressure irrigation system.
  2. If the wound is gaping and still bleeding, you may want to close the wound, especially if transportation to a medical facility is delayed greater than 72 hours. First, to stop the bleeding, you can soak gauze with Afrin® or nasal spray containing Neo-synephrine. Apply this to the wound. This will act as a vasoconstrictor and slow the bleeding enough so you can bandage and take care of the wound. Also gauze soaked in Benadryl® works wonders as nice topical anesthetic.

Most individuals will not have Benzoin and steri-strips with them. In the absence of these medical supplies, tape can be used to temporarily close the wound.

  1. Cut the hair around the wound so the tape will stick.
  2. Do not shave the area as this will induce more bacteria into the wound and increase chances of infection.
  3. Topical antibiotics? Survive Outdoors recommends Bacitracin as opposed to Neosporin. Approximately 10-15% of the general population is allergic to the Neomycin in Neosporin. Many clinics to not even stock Neosporin due to this factor. The absence of a topical antibiotic is fine. Most people in Western society fall prey to wanting to do more than less. In this scenario, less is best.
  4. Bandage the wound. Nonstick Telfa is excellent to apply first with a pressure dressing. Wrap the wound as you would a sprained ankle. Observe for wrapping too tightly, as circulation distal to the wound may be impaired. If the skin away from the wound is close or pale, loosen the bandage.
  5. Splinting is helpful. It decreases movement. When you decrease movement, you decrease bleeding.
  6. Keep the wound dry for 24-hours. Do not get it wet. After the first 24-hours, cover the wound during the day, leave open to air at night. All wounds need oxygen to heal as stated in our eye injury section. Covering of the wound and then leaving it open to air is a fine balance. When the wound is covered too much, the skin around the wound becomes macerated or white in appearance. This is a sign that you have left it covered for too long. If the skin is dry and scaling, you have left it open to the air too long. Clean daily with basic soap and water and dry well.
  7. Observe for signs of infection: Warmth at the wound site, pus draining, redness moving up the extremity (lymphangitis) are all signs of infection. Fever, swollen, tender lymph nodes, and lymphadenitis are advanced signs of infection. If these late signs and symptoms occur, transportation needs to occur quickly.

May your wounds heal infection-free!

 




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