Lacerations

Related Subjects: |Lacerations |Drowning |Hyperkalaemia |Electrical injury |Hypothermia

A laceration is a traumatic wound caused by blunt or sharp force leading to a tear in the skin and underlying tissues. Unlike incisions, lacerations often have irregular, jagged edges and variable depth. Management requires careful assessment to restore tissue integrity, reduce infection risk, and optimise functional and cosmetic outcomes.

🧾 Causes

• 🔪 Sharp trauma: Knives, glass, metal, industrial tools.
• 🤕 Blunt trauma: Falls, road traffic accidents, sports injuries → often associated with crush injury.
• 🐕 Bites: Dog, cat, human bites (high infection risk).
• ⚙️ Occupational injuries: Construction, farming, machinery accidents.

⚠️ Complications

• 🦠 Infection (cellulitis, abscess, tetanus, necrotising fasciitis).
• 💉 Bleeding, haematoma formation.
• 🦴 Damage to underlying structures (tendons, nerves, vessels, joints, bone).
• 🧑‍🦱 Cosmetic concerns – hypertrophic scars, keloids.
• ❌ Poor wound healing in diabetics, immunosuppressed, or smokers.

🔎 Assessment

• 📖 History: Mechanism of injury, time since injury, tetanus status, medical history (e.g., diabetes, anticoagulants).
• 👁️ Examination: Wound size, depth, contamination, involvement of underlying structures. Neurovascular status is key (sensation, motor function, distal pulses).
• 🖼️ Investigations: X-ray if suspicion of foreign body, fracture, or joint involvement.

🛠️ Management Principles

1. 🧼 Wound cleaning & debridement: Irrigate with copious saline, remove debris, trim devitalised tissue.
2. 💉 Haemostasis: Direct pressure, adrenaline-soaked gauze, or ligation of vessels if needed.
3. 🧵 Closure:
   • Primary closure (sutures, staples, tissue adhesive, steri-strips) if wound is clean and <12 hours old (face <24 hours).
   • Delayed primary closure for contaminated wounds (close after 48–72 hours if no infection).
   • Secondary intention for heavily contaminated/infected wounds.
4. 💊 Antibiotics: Not always required. Indicated for contaminated wounds, bites, or immunocompromised patients.
5. 💉 Tetanus prophylaxis: Check vaccination status; give booster or immunoglobulin if indicated.
6. 📋 Aftercare: Keep wound clean, monitor for infection, suture removal timing (face 5 days, scalp 7 days, limb 10–14 days).

🦷 Special Considerations

• 🐕 Bite wounds: Do not close primarily unless on the face. Always give antibiotics (co-amoxiclav first-line in UK).
• 👁️ Facial lacerations: Require careful alignment for cosmetic and functional outcome; consider plastics referral.
• ✋ Hand injuries: Explore thoroughly; tendon/nerve injuries often need specialist repair.

📊 Quick Reference Table

✅ Take-Home Messages

• Lacerations require structured assessment: history, wound inspection, neurovascular check.
• Clean and debride before closure—the solution to pollution is dilution 💧.
• Choose closure method based on contamination, time since injury, and cosmetic importance.
• Never forget tetanus status and bite wound protocols.

Cases

• Case 1 — Kitchen Knife Injury: A 27-year-old chef sustains a 2 cm clean laceration to the palm while cutting vegetables. Plan: Irrigate thoroughly, check tetanus status, simple suturing with non-absorbable nylon, safety-net for infection.
• Case 2 — Glass-Related Cut: A 19-year-old student presents with a 5 cm jagged laceration on the shin after falling through a glass table. Plan: Explore wound for glass fragments, X-ray if suspicion, layered closure if deep, prophylactic antibiotics if contaminated, arrange follow-up for wound review.