Step 1: Pain Control

* Local anesthesia* Most common agent is lidocaine (frequently already in laceration repair kits)* Inject through wound edges (not through epidermis)* This decreases pain* Alternative is digital/regional nerve block

Step 2: Irrigation

* Laceration repair is not a sterile procedure* Copious irrigation is the best method to decrease chance of wound infection* Faucet/sink vs saline

Step 3: Alternative Wound Closure Techniques

* Dermabond/Tissue Adhesive* Works best on easily approximated wound edges and little tension* Commonly used in pediatrics and geriatrics* Staples* Sometimes leaves a poor cosmetic outcome* Commonly used for scalp wounds* Rapidly stops bleeding* Quickest and easiest closure method to perform

Step 4: Choose a Suture Type

* Absorbable (Gut, Monocryl) * Pros: Patient doesn’t need to return for removal* Cons: Loses tensile strength* Non-Absorbable (Prolene)* Pros: Good cosmetic outcomes, easy to see (bright blue)* Cons: Patient must have them removed

Step 5: Repair the Wound

* Gently approximate wound edges* You are not trying to “seal” the wound closed* Primary goal is to improve cosmetic outcome* Keep it simple* Simple interrupted sutures* Instrument tie

Additional Reading

* Laceration Evaluation (EM Clerkship)* Wound Closure for the Emergency Practitioner (LacerationRepair)