Closure of Simple Lacerations
Treat a laceration at home only if it's small, shallow, in an "unimportant
area," and the skin along the laceration matches up perfectly (and remains together
when undisturbed). In general, you should see the doctor for lacerations where:
the cut is gaping.
the edges can be pulled more than 1/8 inch apart with traction on
the cut is over a knuckle.
the cut is on the face or genitals
the cut might be contaminated with foreign material.
the cut was caused by human or animal teeth.
there is numbness, deep pain, or inability to move a part fully.
||Clean the cut. Benzalkonium chloride towelettes or Betadine prep pads can
be used as an antiseptic. After cleaning, dry the skin. Keep the cut closed with direct
pressure until the bleeding is stopped and it tends to remain closed by itself.
Butterfly bandages and Steri-strips will hold without special preparation. But it you
think the wound may be prone to opening (in which case I really recommend you go get
stitches) and are determined to treat it yourself, you may want to prepare the skin so
strips will stick longer and tighter. If you have Benzoin (a "stick-um" liquid),
apply a thin coating on each side of the cut and allow it to dry completely. Nail polish
remover can also be used to remove skin oils for a more secure "hold," but you
must be careful not to get it in the cut.
|To secure the closure, press the skin edges together. (They should fit
perfectly. If not, you have a problem.) Attach the butterfly or Steri to one side and pull
gently across the cut. You can use your other hand to hold the wound closed.
see the skin puckering slightly and the wound looks tightly closed, push the second side
of the butterfly down. For a longer cut, you may need three or four butterflies or Steris.
||When the wound seems closed, move the extremity around to be sure the
wound stays closed and the tapes won't pull off.
Now pad the wound with a non-stick
pad, then gauze placed directly over top. If necessary, trim the pad to fit. If the wound
is on an extremity, bind the dressing with a kling wrap. Secure the bandage with Coban
wrap or tape. See the section on wound dressings.
If you decide to treat a sharp laceration over a moving surface (such as knee, elbow,
or knuckle), you need to provide protection against motion for the first few days. Think
about what you'll do during the 7-10 days' healing time -- and consider stitches.
||The wound has been cleaned. Benzoin has been placed and allowed to dry
completely. Now a Steri-Strip has been placed.
a butterfly bandage can secure a closure -- either to help you ride out with a cut that
will need stitches, or as permanent treatment for minor, sharp cuts.
|Steri-Strips don't stretch. But the skin over this knuckle will. The joint
must be kept from moving until the early healing is complete. Here a short splint of
aluminum with foam has been placed and taped.
Cuts over moving areas
must be secured, so the moving skin doesn't pull the cut back open.
If you're treating the cut at home, leave the butterflies or Steris until they peel off
on their own. Keep the wound covered with a dry dressing and keep it clean. Avoid bumping
the area. It takes between 10 and 14 days before the cut is strong enough for routine duty
without a dressing.
See the doctor if there is redness around the wound, red streaks, swelling, drainage,
fever, tender bumps in the groin or armpit upsteam from the wound, or an unexplained
increase in pain or tenderness. See section on infection.
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