Annals of Emergency Medicine
Volume 34, Issue 3 , Pages 356-367 , September 1999

Laceration Management

Received 5 November 1998 ,Revised 26 January 1999 ,Accepted 22 February 1999.

References 

  1. McCaig LF, Stussman BJ. National Hospital Ambulatory Medical Care Survey: 1996 Emergency Department Summary. Advance data from Vital and Health Statistics, no. 293. Hyattsville, MD: National Center for Health Statistics; 1997;
  2. Singer AJ, Hollander JE, Quinn JV. Evaluation and management of traumatic lacerations. N Engl J Med. 1997;337:1142–1148
  3. Hollander JE, Singer AJ, Valentine S, et al.  Wound registry: Development and validation. Ann Emerg Med. 1995;25:675–685
  4. Alkan M, Gefen Z, Golcman L. Wound infection after simple suture at the emergency ward. Infect Control. 1984;5:562–564
  5. Singer AJ, Hollander JE, Cassara G, et al.  Level of training, wound care practices, and infection rates. Am J Emerg Med. 1995;13:265–268
  6. Robson MC, Duke WF, Krizek TJ. Rapid bacterial screening in the treatment of civilian wounds. J Surg Res. 1973;14:426–430
  7. Quinn JV, Wells GA. An assessment of clinical wound evaluation scales. Acad Emerg Med. 1998;5:583–586
  8. Quinn JV, Drzewieski A, Stiel IG, et al.  Appearance scales to measure cosmetic outcome of healed lacerations. Am J Emerg Med. 1995;13:229
  9. Singer AJ. Clinical wound evaluation scales. Acad Emerg Med. 1998;5:564–566
  10. Majno G. The Healing Hand: Man and Wound in the Ancient World. Cambridge, MA: Harvard University Press; 1975;
  11. Forrest RD. Early history of wound treatment. J R Soc Med. 1982;75:198–205
  12. Wheeler WM. Ants: Their Structure and Behavior. New York: Columbia University Press; 1960;
  13. Cruse PJE, Foord R. A five-year prospective study of 23,649 surgical wounds. Arch Surg. 1973;107:206–209
  14. Howard JM, Barker WF, Culbertson WR, et al.  Post-operative wound infections: The influence of ultra-violet radiation of the operating rooms and various other factors. Ann Surg. 1964;160:32–81
  15. American College of Emergency Physicians . Foresight Issue. 16, September 1990;
  16. Cardany CR, Rodeheaver G, Thacker J, et al.  The crush injury: A high risk wound. J Am Coll Emerg Phys. 1976;5:965–970
  17. Caliendo JE. Surgical masks during laceration repair. J Am Coll Emerg Phys. 1976;5:278–279
  18. Bodiwala GG, George TK. Surgical gloves during wound repair in the accident and emergency department. Lancet. 1982;2:91–92
  19. Ruthman JC, Hendricksen D, Miller RF, et al.  Effect of cap and mask on infection rates. Ill Med J. 1984;165:397–399
  20. Whorl GJ. Repairing skin lacerations: Does sterile technique matter?. Can Fam Physician. 1987;33:1185–1187
  21. Villasenor RA, Harris DF, Barrun GJ, et al.  Powderfree surgical gloves. Ophthalmic Surg. 1984;15:241–243
  22. Ernst AA, Marvez-Valls E, Mall G, et al.  1% Lidocaine versus 0.5% diphenhydramine for local anesthesia in minor laceration repair. Ann Emerg Med. 1994;23:1328–1332
  23. Dire DJ, Hogan DE. Double-blinded comparison of diphenhydramine versus lidocaine as a local anesthetic. Ann Emerg Med. 1993;22:1419–1422
  24. Singer AJ, Hollander JE. Infiltration pain and local anesthetic effects of buffered vs plain 1% diphenhydramine. Acad Emerg Med. 1995;2:884–888
  25. Wilson L, Martin S. Benzyl alcohol as an alternative local anesthetic. Ann Emerg Med. 1999;33:495–499
  26. Bartfield JM, Jandreau SW, Raccio-Robak N. Randomized trial of diphenhydramine versus benzyl alcohol with epinephrine as an alternative to lidocaine local anesthesia. Ann Emerg Med. 1998;32:650–654
  27. Bartfield JM, Gennis P, Barbera J, et al.  Buffered versus plain lidocaine as a local anesthetic for simple laceration repair. Ann Emerg Med. 1990;19:1387–1389
  28. Bartfield JM, Homer PJ, Ford DT, et al.  Buffered lidocaine as a local anesthetic: An investigation of shelf life. Ann Emerg Med. 1992;21:16–19
  29. Brogan GX, Singer AJ, Valentine SM, et al.  Comparison of wound infection rates using plain versus buffered lidocaine for anesthesia of traumatic wounds. Am J Emerg Med. 1997;15:25–28
  30. Bainbridge LC. Comparison of room temperature and body temperature local anaesthetic solutions. Br J Plast Surg. 1991;44:147–148
  31. Brogan GX, Giarrusso E, Hollander JE, et al.  Comparison of plain, warmed, and buffered lidocaine for anesthesia of traumatic wounds. Ann Emerg Med. 1995;26:121–125
  32. Scarfone RJ, Jasani M, Gracely EJ. Pain of local anesthetics: Rate of administration and buffering. Ann Emerg Med. 1998;31:36–40
  33. Krause RS, Moscatti R, Filice M, et al.  The effect of injection speed on the pain of lidocaine infiltration. Acad Emerg Med. 1997;4:1032–1035
  34. Kelly AM, Cohen M, Richards D. Minimizing the pain of local infiltration anesthesia for wounds by injection into wound edges. J Emerg Med. 1994;12:593–595
  35. Morris R, McKay W, Mushlin P. Comparison of pain associated with intradermal and subcutaneous infiltration with various local anesthetic solutions. Anesth Analg. 1987;66:1180–1182
  36. Bartfield JM, Raccio-Robak N, Salluzzo RF. Does topical lidocaine attenuate the pain of infiltration of buffered lidocaine?. Acad Emerg Med. 1995;2:104–108
  37. Bartfield JM, Lee FS, Raccio-Robak N, et al.  Topical tetracaine attenuates the pain of infiltration of buffered lidocaine. Acad Emerg Med. 1996;3:1001–1005
  38. Pryor GJ, Kilpatrick WR, Opp DR. Local anesthesia in minor lacerations: Topical TAC vs lidocaine infiltration. Ann Emerg Med. 1980;9:568–571
  39. Grant SAD, Hoffman RS. Use of tetracaine, epinephrine, and cocaine as a topical anesthetic in the emergency department. Ann Emerg Med. 1992;21:125–135
  40. Bonadio WA, Wagner V. Efficacy of TAC topical anesthetic for repair of pediatric lacerations. Am J Dis Child. 1988;142:203–205
  41. Daya MR, Burton BT, Schleiss MR, et al.  Recurrent seizures following mucosal application of TAC. Ann Emerg Med. 1988;17:646–648
  42. Dailey RH. Fatality secondary to misuse of TAC solution. Ann Emerg Med. 1988;17:159–160
  43. Ernst AA, Marvez-Valls E, Nick TG, et al.  LAT versus TAC for topical anesthesia in face and scalp lacerations. Am J Emerg Med. 1995;13:151–154
  44. White WB, Iserson KV, Criss E. Topical anesthesia for laceration repair: Tetracaine versus TAC. Am J Emerg Med. 1986;4:319–322
  45. Blackburn PA, Butler KH, Hughes MJ, et al.  Comparison of tetracaine-adrenaline-cocaine (TAC) with topical lidocaine-epinephrine (TLE): Efficacy and cost. Am J Emerg Med. 1995;13:315–317
  46. Zempsky WT, Karasic RB. EMLA versus TAC for topical anesthesia of extremity wounds in children. Ann Emerg Med. 1997;30:163–166
  47. Ernst AA, Pomerantz J, Nick TG, et al.  Lidocaine via iontophoresis in laceration repair: A preliminary safety study. Am J Emerg Med. 1995;13:17–20
  48. Singer AJ, Homan CS, McClain SA, et al.  Low frequency sonophoresis: Pathologic and thermal effects in dogs. Acad Emerg Med. 1998;5:35–40
  49. Singer AJ, Shallat J, Valentine S, et al.  Cutaneous tape stripping to accelerate the anesthetic effects of EMLA cream: A randomized controlled trial. Acad Emerg Med. 1998;5:1051–1056
  50. Lynch MT, Syverud SA, Schwab RA, et al.  Comparison of intraoral and percutaneous approaches for infraorbital nerve blocks. Acad Emerg Med. 1994;1:514–519
  51. Syverud SA, Jenkins JM, Schwab RA, et al.  A comparative study of the percutaneous versus intra oral technique for mental nerve block. Acad Emerg Med. 1994;1:509–513
  52. Seropian R, Reynolds BM. Wound infections after preoperative depilation versus razor preparation. Am J Surg. 1971;121:251–254
  53. Rodeheaver GT, Smith SL, Thacker JG, et al.  Mechanical cleansing of contaminated wound with a surfactant. Am J Surg. 1975;129:241–245
  54. Haury B, Rodeheaver G, Vensko J, et al.  Debridement: An essential component of traumatic wound acre. Am J Surg. 1978;135:238–242
  55. Madden J, Edlich RF, Schauerhamer R, et al.  Application of principles of fluid dynamics to surgical wound irrigation. Curr Top Surg Res. 1971;3:85–93
  56. Stevenson TR, Thacker JG, Rodeheaver GT, et al.  Cleansing the traumatic wound by high pressure syringe irrigation. J Am Coll Emerg Phys. 1976;5:17–21
  57. Wheeler CB, Rodeheaver GT, Thacker JG, et al.  Side-effects of high pressure irrigation. Surg Gynecol Obstet. 1976;143:775–778
  58. Edlich RF, Rodeheaver GT, Morgan RF, et al.  Principles of emergency wound management. Ann Emerg Med. 1988;17:1284–1302
  59. Singer AJ, Hollander JE, Subramanian S, et al.  Pressure dynamics of various irrigation techniques commonly used in the emergency department. Ann Emerg Med. 1994;24:36–40
  60. Hollander JE, Richman PB, Werblud M, et al.  Irrigation in facial and scalp lacerations: Does it alter outcome?. Ann Emerg Med. 1998;31:73–77
  61. Dire DJ, Welsh AP. A comparison of wound irrigation solutions used in the emergency department. Ann Emerg Med. 1990;19:704–708
  62. Moscati R, Mayrose J, Fincher L, et al.  Comparison of normal saline with tap water for wound irrigation. Am J Emerg Med. 1998;16:379–381
  63. Faddis D, Daniel D, Boyer J. Tissue toxicity of antiseptic solutions: A study of rabbit articular and periarticular tissues. J Trauma. 1977;17:895–897
  64. Oberg MS, Lindsey D. Do not put hydrogen peroxide or povidine iodine into wounds. J Trauma. 1980;20:323–324
  65. Pigman EC, Karch DB, Scott JL. Splatter during jet irrigation cleansing of a wound model: A comparison of three inexpensive devices. Ann Emerg Med. 1993;22:1563–1567
  66. Morgan WJ, Hutchison D, Johnson HM. The delayed treatment of wounds of the hand and forearm under antibiotic cover. Br J Surg. 1980;67:140–141
  67. Baker MD, Lanuti M. The management and outcome of lacerations in urban children. Ann Emerg Med. 1990;19:1001–1005
  68. Berk WA, Osbourne DD, Taylor DD. Evaluation of the “golden period” for wound repair: 204 Cases from a third world emergency department. Ann Emerg Med. 1988;17:496–500
  69. Singer AJ, Hollander JE. Tissue adhesives for laceration closure [letter]. JAMA. 1997;278:703
  70. Markovchick V. Suture materials and mechanical aftercare. Emerg Med Clin North Am. 1992;10:673–688
  71. Swanson NA, Tromovitch TA. Suture materials, 1980s: Properties, uses, and abuses. Int J Dermatol. 1982;21:373–378
  72. Ratner D, Nelson BR, Johnson TM. Basic suture materials and suturing techniques. Semin Dermatol. 1994;13:20–26
  73. Hollander JE, Blasko B, Singer AJ, et al.  Poor correlation of short and long term appearance of repaired lacerations. Acad Emerg Med. 1995;2:983–987
  74. Mehta PH, Dunn KA, Bradfield JF, et al.  Contaminated wounds: Infection rates with subcutaneous sutures. Ann Emerg Med. 1996;27:43–48
  75. deHoll D, Rodeheaver G, Edgerton MT, et al.  Potentiation of infection by suture closure of dead space. Am J Surg. 1974;127:716–720
  76. Austin PE, Dunn KA, Eily-Cofield K, et al.  Subcuticular sutures and the rate of inflammation in noncontaminated wounds. Ann Emerg Med. 1995;25:328–330
  77. Milewski PJ, Thomson H. Is a fat stitch necessary?. Br J Surg. 1980;67:393–394
  78. Sharp WV, Belden TA, King PH, et al.  Suture resistance to infection. Surgery. 1982;91:61–63
  79. Start NJ, Armstrong AM, Robson WJ. The use of chromic catgut in the primary closure of scalp wounds in children. Arch Emerg Med. 1989;6:216–219
  80. Ritchie AJ, Rocke LG. Staples versus sutures in the closure of scalp wounds: A prospective, double-blind, randomized trial. Injury. 1989;20:217–218
  81. George TK, Simpson DC. Skin wound closure with staples in the accident and emergency department. J R Coll Surg Edinb. 1985;30:54–56
  82. Johnson A, Rodeheaver GT, Durand LS, et al.  Automatic disposable stapling devices for wound closure. Ann Emerg Med. 1981;10:631–635
  83. Brickman KR, Lambert RW. Evaluation of skin stapling for wound closure in the emergency department. Ann Emerg Med. 1989;18:1122–1125
  84. Hollander JE, Giarrusso E, Cassara G, et al.  Comparison of staples and sutures for closure of scalp lacerations [abstract]. Acad Emerg Med. 1997;4:460–461
  85. Panek PH, Prusak MP, Bolt D, et al.  Potentiation of wound infection by adhesive adjuncts. Am Surg. 1972;38:343–345
  86. Rodeheaver GT, Halverson JM, Edlich RF. Mechanical performance of wound closure tapes. Ann Emerg Med. 1983;12:203–207
  87. Rothnie NG, Taylor GW. Sutureless skin closure: A clinical trial. Br Med J. 1963;Oct. 26:1027–1030
  88. Dimensional Analysis Systems: An Evaluation of Acute Incisional Strength with Trauma-seal Surgical Tissue Adhesive Wound Closure [internal document]. Leonin, NJ: Dimensional Analysis Systems; May 1995;
  89. Mizrahi S, Bickel A, Ben-Layish EB. Use of tissue adhesives in the repair of lacerations in children. J Pediatr Surg. 1988;23:312–313
  90. Messi G, Marchi AG. Evaluation of skin laceration repair by tissue adhesive in the pediatric emergency room. Panminerva Med. 1992;34:77–80
  91. Quinn JV, Drzewiecki A, Li MM, et al.  A randomized, controlled trial comparing a tissue adhesive with suturing in the repair of pediatric facial lacerations. Ann Emerg Med. 1993;22:1130–1135
  92. Simon HK, McLario DJ, Bruns TB, et al.  Long term appearance of lacerations repaired using tissue adhesive. Pediatrics. 1997;99:193–195
  93. Simon HK, Zempsky WT, Bruns TB, et al.  Lacerations against Langer’s lines: To glue or suture?. J Emerg Med. 1998;16:185–189
  94. Quinn JV, Wells GA, Sutcliffe T, et al.  A randomized trial comparing octylcyanoacrylate tissue adhesive and sutures in the management of traumatic lacerations. JAMA. 1997;277:1527–1530
  95. Quinn JV, Wells GA, Sutcliffe T, et al.  Tissue adhesive vs. suture wound repair at one year: Randomized clinical trial correlating early, three-month, and one year cosmetic outcome. Ann Emerg Med. 1998;32:645–649
  96. Singer AJ, Church AL, Forrestal K, et al.  Comparison of patient and practitioner satisfaction with wound appearance after traumatic wound repair. Acad Emerg Med. 1997;4:133–137
  97. Barefoot J, Toriumi D, Thorn M, et al.  Food and Drug Administration Physician Advisory Panel Presentation. January 31, 1998; Rockville, MD
  98. Quinn JV, Maw JL, Ramotar K, et al.  Octylcyanoacrylate tissue adhesive wound repair versus suture wound repair in a contaminated wound model. Surgery. 1997;122:69–72
  99. Singer AJ, Hollander JE, Valentine SM, et al.  Prospective randomized controlled trial of tissue adhesive (2-octylcyanoacrylate) vs standard wound closure techniques for laceration repair. Acad Emerg Med. 1998;5:94–99
  100. Bruns TB, Robinson BS, Smith RJ, et al.  A new tissue adhesive for laceration repair in children. J Pediatr. 1998;132:1067–1070
  101. Applebaum JS, Zalut T, Applebaum D. The use of tissue adhesion for traumatic laceration repair in the emergency department. Ann Emerg Med. 1993;22:100–101
  102. Maw JL, Quinn JV, Wells GA, et al.  A prospective comparison of octylcyanoacrylate tissue adhesive and sutures for the closure of head and neck incisions. J Otolaryngol. 1997;26:26–30
  103. Hollander JE, Singer AJ, for the Stony Brook Octylcyanoacrylate Study Group . Application of tissue adhesives: Rapid attainment of proficiency. Acad Emerg Med. 1998;5:1012–1017
  104. Quinn JV, Osmond MH, Yurack JA, et al.  N-2-Butylcyanoacrylate: Risk of bacterial contamination with an appraisal of its antimicrobial effects. J Emerg Med. 1995;13:581–585
  105. Osmond MH, Klassen TP, Quinn JV. Economic comparison of a tissue adhesive and suturing in the repair of pediatric facial lacerations. J Pediatr. 1995;126:892–895
  106. Schauerhamer RA, Edlich RF, Panek P, et al.  Studies in the management of the contaminated wound: VII. Susceptibility of surgical wounds to postoperative surface contamination. Am J Surg. 1971;122:74–77
  107. Winter JD. Effect of air exposure and occlusion on experimental human skin wounds. Nature. 1963;194:377
  108. Winter JD. Formation of the scab and the rate of epithelization of superficial wounds in the skin of the young domestic pig. Nature. 1962;193:293–294
  109. Smack DP, Harrington AC, Dunn C, et al.  Infection and allergy incidence in ambulatory surgery patients using white petrolatum vs bacitracin ointment. JAMA. 1996;276:972–977
  110. Dire DJ, Coppola M, Dwyer DA, et al.  A prospective evaluation of topical antibiotics for preventing infections in uncomplicated soft-tissue wounds repaired in the ED. Acad Emerg Med. 1995;2:4–10
  111. Austin PE, Matlack R, Dunn KA, et al.  Discharge instructions: Do illustrations help our patients understand them?. Ann Emerg Med. 1995;25:317–320
  112. Cummings P, Del Beccaro MA. Antibiotics to prevent infection of simple wounds: A meta-analysis of randomized studies. Am J Emerg Med. 1995;13:396–400
  113. Day TK. Controlled trial of prophylactic antibiotics in minor wounds requiring suture. Lancet. 1975;2:1174–1176
  114. Grossman JAI, Adams JP, Kunec J. Prophylactic antibiotics in simple hand lacerations. JAMA. 1981;245:1055–1056
  115. Roberts A, Teddy P. A prospective trial of prophylactic antibiotics in hand lacerations. Br J Surg. 1977;64:394–396
  116. Thirlby RC, Blair AJ, Thal ER. The value of prophylactic antibiotics for simple lacerations. Surg Gynecol Obstet. 1983;156:212–216
  117. Cummings P. Antibiotics to prevent infection in patients with dog bite wounds: A meta-analysis of randomized trials. Ann Emerg Med. 1994;23:535–540
  118. Steele MT, Riedel Sainsbury C, Robinson WA, et al.  Prophylactic penicillin for intraoral wounds. Ann Emerg Med. 1989;18:847–852

 From the Department of Emergency Medicine, University of Pennsylvania, Philadelphia, PA, * and the Department of Emergency Medicine, State University of New York at Stony Brook, Stony Brook, NY.

☆☆ Editor’s note: This article continues a series of special contributions addressing state-of-the-art techniques, topics, or concepts. State-of-the-art articles will be featured in Annals on a regular basis in the next several volumes.

 Hoechst Marion Roussel provided honoraria to the authors of this state-of-the-art article. Annals is grateful to Hoechst Marion Roussel for their continued support of emergency medicine.

★★ Address for reprints: Judd E Hollander, MD, Department of Emergency Medicine, Ground Floor, Ravdin, Hospital of the University of Pennsylvania, 3400 Spruce Street, Philadelphia, PA 19104-4283; 215-662-2767, fax 215-662-3953; E-mail jholland@mail.med.upenn.edu.

 0196-0644/99/$8.00 + 0

♢♢ 47/1/98305

PII: S0196-0644(99)70131-9

Annals of Emergency Medicine
Volume 34, Issue 3 , Pages 356-367 , September 1999