Definition & Overview
A laceration repair is a procedure used to treat tears or cuts that affect the skin and its underlying tissues, including the subcutaneous fat, muscles, and tendons. The procedure involves cleaning the wound and preparing it for repair with the goal of closing it. While minor cuts do not require medical intervention, large, deep, and open lacerations should be repaired medically to prevent complications such as excessive bleeding, wound infection, and severe scarring.
There are now several techniques used to repair lacerations. Modern techniques such as skin glue, adhesive strips, and staples take the place of conventional stitches and sutures when appropriate.
Who Should Undergo and Expected Results
Laceration repair is recommended for patients with:
- Wounds that expose or injure the deeper structures such as the muscle, fat, tendon, or bone
- Facial wounds that affect facial nerves, parotid or lacrimal ducts, and the eye’s medial canthus
- Wounds with impaired blood supply
- Wounds with dirt and debris that cannot be removed with basic cleaning
- Wounds that cause heavy, prolonged bleeding that does not subside even after pressure is applied for 15 minutes
- Cuts with uneven or jagged edges
- Wounds that are 1/8 to ¼ of an inch deep
- Wounds on high-stress parts of the body, such as the hands, feet, chest, and joints
- Wounds caused by broken glass, which requires patients to undergo an x-ray scan to ensure that no fragments of glass are retained in the skin
Lacerations that are treated immediately are more likely to be repaired without any complications. Thus, patients who suffer from wounds described above should seek medical attention right away or at least 8 hours following the time of injury. The longer it takes for the wound to be repaired, the higher the risk of infection. Thus, some doctors no longer repair lacerations that are more than 8 hours old due to the high risk of infection.
A successful laceration repair procedure will cause the wound to close and will facilitate fast and uncomplicated healing with very minimal scarring.
How is the Procedure Performed?
Laceration repair can be done both surgically and non-surgically. Regardless of which technique is used, the wound is initially cleansed and closely examined to determine what kind of repair is appropriate to use. If some tissues around the wound are too damaged to be repaired, a debridement will be performed first followed by the laceration repair procedure.
Non-surgical techniques include:
Dermabond glue – This tissue adhesive glue works best on wounds that are up to 3-cm in length and with clean edges, are not too deep, and are not in high-tension areas. The Dermabond layer falls off on its own within 5 to 10 days after application.
Steristrips or adhesive strips – This method is effective in repairing simple lacerations without movement or tension. The strips are placed along the wound with sufficient space in between to allow fluid from the wound to drain properly, which is important to prevent infections. After the strips are placed, the area should be kept dry for at least 72 hours.
Staples – Skin staples are best used for lacerations on the scalp, neck, arms, and legs. To repair a laceration using staples, the wound is first cleansed and the cut edges are aligned before the wound is stapled shut. The wound is then protected by Tegaderm or a special clear acrylic dressing. The staples, like non-dissolvable stitches, have to be removed by the doctor after 5-10 days.
Surgical methods are performed differently depending on the location of the wound as this factor greatly affects the conditions during the repair procedure. For example, when it comes to scalp wounds, profuse bleeding may be expected. For injuries to the cheek, swelling around the wound may cause the eye/s to become closed and facial nerves and muscles may be affected. For mouth lacerations, there is a possibility of gum injury, which needs to be referred to a dental or maxillofacial specialist. These are just some of the special considerations that have to be made when deciding on the surgical methods to use based on the location of the laceration.
Furthermore, some cases of laceration repair may require the use of sedatives or anesthesia, depending on the extent of the injury. Different types of anesthetics may be used including topical anesthesia such as ALA (adrenaline lignocaine amethocaine), local anesthesia, regional nerve block, or a Bier’s Block.
Possible Risks and Complications
Patients who undergo a laceration repair face an increased risk of:
- Wound infection caused by bacteria
- Bleeding or blood loss
- Allergic reaction to anesthetics used during the procedure
- Poor wound closure
- Re-opening of the wound
Patients are advised to watch out for signs of complications, which include:
- Swelling that does not subside
- Pus drainage
- Excessive bleeding that does not seem to subside or decrease
- Muscle spasms or rigidity around the wound
- Red streaks around the wound site
- Fever and chills, which are indicative of an infection
Several steps can be taken to prevent the abovementioned complications. Following a successful laceration repair, patients are typically given antibiotics, especially when tissue damage was extensive or some contamination of dirt or other substances were involved. Aside from potential bacterial infection, wound sufferers are also usually evaluated for tetanus infection. If necessary, they will be given a tetanus vaccination. This is commonly done when the patient has never received a previous vaccination or has not had a vaccination for the last five years.
As for scarring, most lacerations cause some scars after healing, although the degree of scarring varies greatly for each case. This may be influenced, however, by several factors, such as the location and size of the wound, the physician’s skill or how the repair was performed, as well as the patient’s history of scarring or keloids formation. If severe scarring is experienced, patients may also consider plastic surgery to improve the appearance of the affected body part.
Thomsen T, Barclay D, Setnik G. (2006). “Basic Laceration Repair.” New England Journal of Medicine. http://www.nejm.org/doi/full/10.1056/NEJMvcm064238
“Lacerations: Clinical Practice Guidelines.” The Royal Children’s Hospital Melbourne. http://www.rch.org.au/clinicalguide/guideline_index/Lacerations/
“Laceration Repair.” University of Virginia Health System. https://uvahealth.com/services/plastic-surgery/conditions-treatments/laceration-repair