Skin Laceration and Abrasion Care



100
75% 100% Zoom 125%


Export to PDF
Contribute Edits
Skin Laceration and Abrasion Care

Contraindications to epinepherine?

Intranasal or Oral midazolam 20 min prior to procedure

Midazolam 10mg/mL intranasal solution
Midazolam suspension
Inclusion Criteria
  • Simple skin laceration or abrasion
Exclusion Criteria
  • Complex anatomical location (auricle, intraoral, eyelid involvement, genital or rectal involvement)
  • Deep muscle, tendon or neurovascular involvement
  • Deep puncture wounds
  • Animal or human bites
  • High tension skin areas
  • Active signs of infection
  • Complex nature of wound

Hemostatis obtained?

Will patient need tetanus prophylaxis?

Consult advanced provider in wound repair

Sutures

  • Determine suturing technique
  • Determine type of suture material
  • Place sutures
  • Determine need for antibiotics
  • Apply topical antibiotics and bandage

Tissue adhesive

  • Ensure complete hemostasis & skin is dry
  • Approximate skin margins with forceps or fingers
  • Apply a thin strip along the wound
  • Allow to dry for 30-40 sec while holding skin
  • Repeat process 3 - 4 times

Patient to require sedation?

Patient to require anxiolysis?

Irrigate and clean area with clean tap water, apply topical antibiotics if indicated, sunscreen advice, consider delayed closure

Diet NPO

Contraindications to LET

  • Lacerations of mucous membranes
  • Lacerations to areas of potential vascular compromise (eg, digits, penis, ear, nose)
  • Grossly contaminated wounds
  • Patients with allergy to amide or ester local anesthetics
  • Lacerations > 5cm

Risk for concerning foreign body?

Patient to benefit from regional nerve block?

Perform regional nerve block

Contraindications to LET?

Clean the area around the wound with providone-iodine or chlorhexidine. Do not scrub the wound itself with these solutions.

Inadequate analgesia?

Contraindications to midazolam

  • History of adverse event
  • Current disease process causing myocardial depression
  • Patients at risk for hypoventilation

Contraindications to lidocaine with epinephrine

  • Peripheral vascular disease
  • History of hypersensitivity to local anesthetics of the amide type
  • Patient with disease process that make them susceptible to epinephrine (HTN, CV disease, etc.)
  • Dirty or contaminated wounds

Wound irrigation and preparation. Start primary closure.

Wound closure tapes

  • Dry area around wound site
  • Place central strip first (pinch wound)
  • Place tapes 1/8 inch (3mm) apart
  • Add parallel strips to reduce tension

Staples

  • Approximate skin margins with forceps or fingers
  • Place central staple first
  • Place staples 0.5 - 1 cm apart along wound
  • Apply topical antibiotics and bandage

Tetanus, diphtheria, acellular pertussis vaccine (TDaP) injection

Techniques to achieve hemostatis

  • Constant Pressure for 10-15 min
  • Injection of 1% lidocaine with epinephrine
  • Absorbable gelatin foam
  • Use of a BP cuff at 10 mmHg above systolic pressure applied to proximal end of extremity with wound after elevating the extremity for 1 min to allow venous drainage.
  • Large extremity tourniquets (30-60 min)
  • Digital tourniquets (20-30 min)

Contraindications to tissue adhesive

  • High skin tension
  • Complex wounds (stellate, crush)
  • Wounds over joints unless immobilized
  • Mucosal surfaces
  • Hairy areas unless trimmed
  • Concern for infection (bites, punctures, etc.)
  • Allergy or sensitivity

Contraindications to nitrous oxide

  • History of adverse event
  • Vomiting
  • Pregnancy
  • Gas within body cavities (SBO, Pneumothorax, Otitis Media, etc)

Consider x-ray to identify radiopaque materials

Wound will need primary closure?

Hair removal

  • Hair should only be gently combed or trimmed away from wound margins.

Hair apposition

  • Appose hair across the wound
  • Rotate 2 -3 times
  • Apply small drop of tissue adhesive
  • Repeat along the length of the wound

Place LET 30-45 min prior to procedure

LET (lidocaine, epinephrine, tetracaine) topical solution

1% lidocaine field block

Lidocaine 1% injection

1% lidocaine with epinephrine field block

Lidocaine 1% with epinephrine injection