Lacerations Flashcards
What are the complicated lacerations that may require special skills
3rd degree perineal tears
Lip or eyelid lacs - Lip - muscle, then vermilion border, then rest
Arterial lacs
PMH - DM, immunosuppressed, keloid former
Which lacs are at risk of Tetanus?
> 6hrs, >1cm deep
Crush, burn, gunshot, puncture
Contaminated, FB
How to determine incision length, width + placement
Ellipset w/ 30 corners, length 3x longer than width
Use Langer’s lines
Types of suture
Ethilon + Prolene – non-dissolvable, Vicryl – dissolvable
Face - fast cut, everywhere else - chromic
Deep - muscle = vicryl, subcut = monocryl
Suture sizes + when to use
6-0 = face
5-0 = fingers + toes
4-0 = arms + legs
3-0 = torso + back
2-0 = scalp
lidocaine duration + max dose (w + w/o epi)
Lidocaine
46-60 mins
5mg/kg (28ml)
Lido w/ epi
2-6 hrs
7mg/kg (50ml)
mepivacaine onset, duration + max dose
3-5 mins
45-90 mins
7mg/kg (50ml)
bupivacaine onset, duration + max dose
5 mins
2-4 hrs
3mg/kg (70ml)
When to remove sutures
Scalp = 2 weeks
Face = 5 days
Hands = 5 days
Arms = 10 days
Legs = 2 weeks
Chest + torso = 2 weeks
Joints = 2 weeks
Bacteria in dog/ cat bites
Pasteurella multocida
S aureus
S viridans
Rx for dog/ cat bites
Consider rabies IgG (20 IU/kg around wound or IM)
Rabies vaccine 1ml deltoid day 3, 7, 14, 28
Rx: tetanus, amox-clav or doxy
Bacteria in human bites
Staph
Alpha-hemolytic strep
Eikenella corrodens
Bacteroides
Complication of lacerations
Flexor tendon lacs
Open fractures
Neurovascular injury
FB
How to optimise cosmetic results
Layer closure
Revise if needed
Regional anesthesia
Making lido less painful
buffer with bicarbonate, warm the lido, inject slowly at perpendicular angle to skin
