Minor injuries: laceration repairs
BMJ 2023; 380 doi: https://doi.org/10.1136/bmj-2021-067573 (Published 13 January 2023) Cite this as: BMJ 2023;380:e067573
- Isabelle N Colmers-Gray, assistant professor1,
- Aven Crawshay, rural family and emergency medicine physician2,
- Curtis Budden, assistant professor3
- 1Queen’s University, Department of Emergency Medicine, Kingston, Ontario, Canada
- 2Prince Rupert Regional Hospital, Prince Rupert, British Columbia, Canada
- 3University of Alberta, Faculty of Medicine and Dentistry, Department of Surgery, Edmonton, Alberta, Canada
- Correspondence to I Colmers-Gray isabelle.gray{at}queensu.ca
What you need to know
Consider the type of injury (laceration, puncture, crush, abrasion), anatomical location, and patient characteristics when planning an approach to wound repair
Manage precipitating factors that led to the injury (eg, syncope)
All lacerations require irrigation prior to closure and consideration of tetanus prophylaxis, but only certain patients and laceration types require antibiotic prophylaxis
Lacerations are a common presentation in urgent and emergency care settings. In this article we discuss a basic approach to wound management, when to provide antibiotic prophylaxis, and when to involve a specialist. Readers may have varied training, experience, and practice setting(s); therefore we recommend referring to local expertise, resources, and protocols when appropriate.
Initial assessment
When assessing a patient with a laceration, consider the following:
Elicit when and how the injury occurred and manage precipitants, such as a syncope, self-harm, or substance use.
Assess for additional injuries, paying special attention to areas not immediately visible, such as the axillas, scalp, and back.
For upper limb injuries, determine hand dominance, occupation, and important recreational activities (eg, sports, playing musical instruments).
Conduct a neurovascular examination for pulses, capillary refill, sensation, and motor function—especially for hand, foot, and facial injuries.
Where appropriate, request imaging to rule out underlying fractures or foreign bodies.
Consider taking medical photographs (document consent), or photographs on the patient’s mobile device, to track wound progression.
Note factors that may impair healing or increase infection, including peripheral vascular disease, diabetes, heavy alcohol use, smoking, steroids, immunodeficient states, extremes of age, or malnutrition.
Ask about tetanus vaccination status and antiplatelet/anticoagulant medications. Offer tetanus prophylaxis per regional guidelines.123
Management
If the wound is actively bleeding
Apply gauze and pressure over the wound. Most arterial bleeding stops with continuous direct digital pressure for at least 5-10 minutes (don’t be tempted to check before that time has elapsed). If bleeding continues, some wounds are amenable to …
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