Background Information:

What are the other Names for the Procedure?

• Wound Repair

What is Laceration Repair surgical procedure?

• A laceration is an open wound in the skin that can extend to underlying tissue and occasionally to the muscles, surrounding blood vessels, and surrounding nerves. Lacerations may be deep or shallow, wide, or narrow
• Laceration Repair is the method of cleaning and closing a lacerated wound. The indications for performing a Laceration Repair include:
  • Lacerations that are greater than 1/8th to 1/4th of an inch deep
  • Wounds bleeding even after applying pressure for 10-15 minutes
  • Unclean wounds
  • Wounds with exposed fat, muscle, tendon, or bone
  • Lacerations with jagged edges

What part of the Body does the Procedure involve?

A Laceration Repair involves the skin and some underlying tissue.

Why is the Laceration Repair surgical procedure Performed?

Laceration Repairs are performed for the following reasons:

• Preventing excessive bleeding and infection of the lacerated wound
• Closing the lacerated wound, in order to accelerate healing
• Repairing a laceration generally produces better cosmetic results

However, it should be noted that a laceration that has remained open for greater than 8 hours, is generally not repaired, due to a great risk of infection.

What are some Alternative Choices for the Procedure?

Currently, there is no other alternative to a Laceration Repair procedure. Deep, large, bleeding, dirty, or extensive lacerations have to be repaired.

What are the Recent Advances in the Procedure?

Uses of advanced suture material and non-suture surgical glues are recent advances for Laceration Repair. 

What is the Cost of performing the Laceration Repair surgical procedure?

The cost of Laceration Repair procedure depends on a variety of factors, such as the type of your health insurance, annual deductibles, co-pay requirements, out-of-network and in-network of your healthcare providers and healthcare facilities.

In many cases, an estimate may be provided before the procedure. The final amount depends upon the findings during the surgery/procedure and post-operative care that is necessary.

When do you need a Second Opinion, prior to the Procedure?

• It is normal for a patient to feel uncomfortable and confused with a sudden inflow of information regarding Laceration Repair procedure and what needs to be done
• If the patient needs further reassurance or a second opinion, a physician will almost always assist in recommending another physician
• Also, if the procedure involves multiple surgeries or has many alternatives, the patient may take a second opinion to understand and choose the best one. They can also choose to approach another physician independently

What are some Helpful Resources?

http://www.surgery.com/procedure/laceration-repair/ (accessed on 08/02/2014)

http://uvahealth.com/services/plastic-surgery/conditions-treatments/101013 (accessed on 08/02/2014)

Complete Guide to Symptoms, Illness & Surgery; Written by H Winter Griffith, M.D.; Revised and updated by Stephen Moore, M.D. and Kenneth Yoder, M.D.; The Berkley Publishing Group, 5^th Edition, New York, 2006

Prior to Laceration Repair surgical procedure:

How is the Laceration Repair surgical procedure Performed?

A Laceration Repair procedure is performed as:

• The laceration is first inspected to determine the extent of tissue damage and to look for the presence of any debris and injury to underlying structures, such as muscle, tendons, nerves, blood vessels, or bones
• The presence of extensive tissue damage, calls for a specialized management of the condition
• The laceration is then thoroughly cleaned by irrigating it with saline solution, to remove any contained debris. The surrounding hair on the skin may be cut. An antiseptic solution may be used to clean around the wound
• Tissue that has been severely damaged will be removed; a procedure called debridement. If the wound edge is uneven, it may be trimmed

The laceration is then repaired using one of the following methods:

• Suturing
  • This is done under local anesthesia for wounds that are large, deep, or with uneven edges

  • Subcutaneous tissue (tissue under the skin) if damaged, is stitched using absorbable suture material. These stitches are absorbed by the body and need not be removed at a later date

  • The skin is closed using non-absorbable suture material

  • The area is then washed with a saline solution. An antiseptic ointment is applied and the wound is dressed

• Dermabond
  • This can be used for small lacerations on the legs, arms, torso, and face
  • The wound edges are held close to each other and dermabond is applied over the ‘approximated’ wound 3 times.      
  • This acts like glue and the laceration is held shut for 60 seconds, after applying the dermabond
  • The area is then cleaned and dressed
• Steristrips
  • These are used for shallow and clean lacerations with straight edges
  • The skin edges are approximated and the steristrip is applied. It acts like an adhesive tape and holds the skin edges together
• Staples
  • May be used for lacerations over neck, arms, torso, legs, or the scalp
  • The surrounding skin is disinfected with iodine
  • The wound edges are then approximated and stapled to each other
  • The wound is dressed after applying antiseptic ointment

Depending on the immunization status of the individual, a tetanus shot may/may not be administered.

Where is the Procedure Performed?

A Laceration Repair procedure is usually performed in an out-patient surgery center facility, an emergency room, or a hospital. Usually, the individual can go home, after the procedure is completed.

Who Performs the Procedure?

The Laceration Repair procedure is performed by any of these medical personnel:

• Family physician
• General surgeon
• Plastic surgeon
• Reconstructive surgeon
• Orthopedic surgeon
• Hand surgeon

How long will the Procedure take?

The time taken for a Laceration Repair process depends on the extent of the laceration. However, the actual procedure usually takes a few minutes.

What do you need to tell your Physician before the Procedure?

It is very important to provide the following information to your healthcare provider. This enables your healthcare provider in assessing the risks for the Laceration Repair procedure and helps avoid unnecessary complications.

• Provide a complete list of medications you are currently, taking to your physician. This information is useful for a variety of reasons. For example, it can help your healthcare provider prevent complications due to a drug interaction
• If you are allergic to any specific medication or food items
• If you are taking blood thinners, such as aspirin, warfarin, herbal supplements, or any other such medications
• If you or your family members, have a history of bleeding disorders, or if there is a tendency to bleed more than normal
• If you have diabetes, high blood pressure, chest pains, or have previously suffered from a heart attack
• If you have ever been diagnosed with blood clots in your leg (deep vein thrombosis) or lung (embolism of lung)
• If you have a history of frequent bone fractures (this may affect bone-healing, if bones are involved as part of your procedure)
• A list of all previous surgical procedures you have undergone, like for example: Removal of appendix, gallbladder, or any other part, of your body; surgical repair of any body part, such as hernia repair, perforation of bowel wall, etc.

What Preparations are needed, prior to the Procedure?

• The physician may evaluate the individual’s medical history to gain a comprehensive knowledge of the overall health status of the patient including information related to the medications that are being currently taken
• Some medications increase a person’s chances of bleeding and it may be recommended to discontinue them for a period of time, before the procedure is performed
• Blood tests may be performed to determine if there is a bleeding tendency or any other medical conditions that prevents the person from undergoing the procedure
• Normally local anesthesia is used; however do inform the physician if you are allergic to any local anesthetics, lidocaine, etc.
• Avoid application of any cosmetics, deodorant, or topical medicines on the area, prior to the procedure
• It is advisable to quit smoking and the use of any nicotine based products, for a while, before the surgery
• Consumption of alcoholic drinks must also be avoided for a period of time, as instructed
• The patient must avoid eating or drinking at least 8 hours prior to the surgical procedure, depending on when the procedure is arranged
• For persons suffering from diabetes, it is important that the blood sugar stays within the normal range; if not their diabetologist may have to control blood sugar by recommending insulin and/or a combination of oral medicines
• Primary wound care at home involves washing and applying direct pressure to lacerations, to control bleeding. The laceration may also be washed with running water

What is the Consent Process before the Procedure?

A physician will request your consent for Laceration Repair procedure using an Informed Consent Form.

Consent for the Procedure: A “consent” is your approval to undergo a procedure. A consent form is signed after the risks and benefits of the procedure, and alternative treatment options, are discussed. This process is called informed consent.

You must sign the forms only after you are totally satisfied by the answers to your questions. In case of minors and individuals unable to personally give their consent, the individual’s legal guardian or next of kin, shall give their consent for the procedure.

What Tests are needed, before the Laceration Repair surgical procedure?

Generally, no routine tests are needed before a Laceration Repair. However, if the physician suspects damage to the underlying bone, an x-ray may be ordered.

What are some Questions for your Physician?

Some of the basic questions that you might ask your physician are as follows:

• What is a Laceration Repair?
• Why is this procedure necessary?  How will it help?
• How soon should I get it done? Is it an emergency?
• Who are the medical personnel involved in this procedure?
• Where is the procedure performed? 
• What are the risks while performing the procedure?
• What are the complications that might take place, during recovery?
• How long will it take to recover? When can I resume normal work?
• How many such procedures have you (the physician) performed?
• Are there any follow-up tests, periodic visits to the healthcare facility required, after the procedure?
• What are the costs involved?

During the Laceration Repair surgical procedure:

What kind of Anesthesia is given, during the Procedure?

• Local anesthesia by injection is administered prior to a Laceration Repair procedure
• Very extensive lacerations may sometimes be repaired under general anesthesia

How much Blood will you lose, during the Procedure?

• The blood loss occurs as a result of the laceration and not due to the Laceration Repair procedure
• The amount of blood lost depends on the extent of the injury

What are the possible Risks and Complications during the Laceration Repair surgical procedure?

There are general factors that increase the risk of getting complications during surgery and they include:

• Obesity: Generally greater the degree of obesity, greater is the surgical risk
• Smoking: Longer the smoking history (in pack years smoked), greater the surgical risk
• Advancing age
• Poorly controlled diabetes, as evidenced by a high hemoglobin A1c and a high fasting glucose
• Poorly functioning kidney, as evidenced by increased BUN (blood urea nitrogen) and blood creatinine
• Poorly functioning liver, as evidenced by increased blood liver function tests
• Hypertension (increased blood pressure), especially if it is poorly controlled
• Poor nutritional status (malnutrition with mineral and vitamin deficiencies)
• Poor lung function, as evidenced by abnormal lung function tests
• History of bleeding disorders
• Longstanding illness, such as autoimmune disorders, chronic infections
• Poor immune system due to a variety of causes

The possible risks or complications that may arise during the Laceration Repair procedure are:

• Continued bleeding from the wound
• Infection of the surgical wound
• Allergic reaction to the anesthetic agent

What Post-Operative Care is needed at the Healthcare Facility after the Laceration Repair surgical procedure?

• At the healthcare facility, usually there is no requirement for any post-procedure care, unless any complications arise
• Depending on one’s immunization status, a tetanus shot may be or may not be required
• Antibiotics may be prescribed

After the Laceration Repair surgical procedure:

What are the possible Risks and Complications after the Laceration Repair surgical procedure?

The possible risks and complications that may arise after a Laceration Repair include:

• Infection in the wound

What is the Prognosis after the Surgery?

A complete recovery from a Laceration Repair procedure is normally achieved. The prognosis is usually excellent, without any serious complications being noted.

When do you need to call your Physician?

Do contact your physician, if you notice any of the following symptoms:

• Pain that worsens and swelling of the surgical wound
• Bleeding or fluid drainage from the surgical wound
• Signs of an infection
• Fever, feeling sick
• Dizziness
• Muscle aches, headache
• Muscle stiffness
• Complications associated with prescription medications used in treatment

What Post-Operative Care is needed at Home after the Laceration Repair surgical procedure?

At home, the following post-operative care is recommended, after a Laceration Repair procedure:

• After the repair, keep the wound area dry for at least 24 hours
• Once showering is resumed, avoid soaking the wound in water. Gently wash the surgical wound with an unscented soap. Avoid washing the wound with iodine or hydrogen peroxide
• If excessive bleeding occurs after the procedure, forcefully apply a clean tissue or napkin on the surgical wound and/or elevate the extremity (if the wound is on the arm or leg)
• Apply antibiotic ointment to the surgical wound, before redressing it with a clean bandage
• Avoid activities that stress the injured area
• Complete the course of prescribed medication, under advice of the physician
• Take antibiotic medication to help combat or prevent infection; analgesics may be used, if needed
• Have a follow-up visit to the physician for removal of sutures or staples. This is usually done sometime in the second week, following Wound Repair

How long does it normally take to fully recover, from the Procedure?

It usually takes approximately 2 weeks for wounds to heal, following a Laceration Repair.

Additional Information:

What happens to tissue (if any), taken out during the Procedure?

The tissue is disposed as per the standard medical procedure.

When should you expect results from the pathologist regarding tissue taken out, during the Procedure?

• The tissue removed is processed in the laboratory under a pathologist's supervision
• Slide(s) are prepared once the tissue is processed and is examined by a pathologist and a pathology report issued
• Depending on the complexity of the case, issue of the report may take anywhere between 72 hours to a week's time

Who will you receive a Bill from, after the Laceration Repair surgical procedure?

It is important to note that the number of bills that the patient may receive depends on the arrangement the healthcare facility has with the physician and other healthcare providers.

Sometimes, the patient may get a single bill that includes the healthcare facility and the consultant physician charges. Sometimes, the patient might get multiple bills depending on the healthcare provider involved. For instance, the patient may get a bill from:

• A hospital
• Family doctor, general surgeon, plastic surgeon, reconstructive surgeon, orthopedic surgeon, or a hand surgeon

The patient is advised to inquire and confirm the type of billing, before the Laceration Repair procedure is performed.

Thanks and Gratitude:

We sincerely acknowledge and thank Dr. Douglas J. Jones for reviewing the article. His valuable input and feedback has helped enrich the contents of this article.

Douglas J. Jones, MD FACS
Board Certified General Surgeon and Faculty Member
University of Illinois, College of Medicine at Urbana-Champaign
506 S. Mathews Ave., Urbana, IL 61801, USA