Treatment of Lacerations

Treatment Methods

1. Classification by wound contamination

Wounds are classified according to the degree of contamination as clean wounds, clean-contaminated wounds, contaminated wounds, and dirty wounds. Most lacerations are contaminated or dirty wounds, so it is important to remove necrotic tissue and contaminants.

2. Debridement

When you go to the hospital, the doctor examines the wound area and removes pieces of skin that are judged unlikely to survive after suturing because of the severity of the injury, as well as pieces of skin that are already dead. This is called debridement. Debridement helps new skin regenerate by removing skin with no chance of survival and also helps prevent infection by stopping bacteria from invading dead skin tissue. If needed, proper debridement can help the wound heal beautifully and minimize the risk of complications after suturing.

However, patients or caregivers should not hastily assume that tissue fragments that have come off at the accident scene are already dead tissue and throw them away, or leave them behind when coming to the hospital. It is best to bring them to the hospital with the patient and have a doctor make the judgment.

3. Suturing

If necessary, a laceration is treated by suturing. Because most lacerations are small in extent, they can heal with simple suturing alone. Suturing keeps the torn skin edges as close together as possible, helping prevent bleeding and infection, preserve tissue function and appearance, and allow the wound to heal quickly. Suturing has better treatment outcomes when done earlier, so it is best to perform it as soon as possible. It must also be done in a hospital by a qualified person using sterilized instruments and supplies. In the past, suturing was mainly done with thread, but when the wound is not very deep, staples, tape, and other suturing materials are now also used in addition to thread. Each material has its own advantages and disadvantages, but they all follow the same principle of attaching the skin tissue and keeping it fixed in a stable state for a certain period of time.

The method of suturing may also differ depending on the degree of wound contamination. When the wound is clean and not heavily contaminated, primary closure is mainly performed, which means suturing it right away. However, if the wound is dirty and heavily contaminated, secondary closure may be performed, leaving it open to heal naturally rather than closing it immediately. There is also tertiary closure, in which the wound is contaminated and is sutured later after debridement and antibiotic treatment during the first few days.

4. Removal of sutures

The timing for removing sutures is not fixed; the doctor decides after observing the degree of wound recovery. Wound healing is affected by how much the area around the wound moves, and healing may also be influenced by the patient’s age, nutritional status, presence of infection, use of steroid medications, whether radiation therapy was given, and whether anticancer drugs are being used. In general, the timing of removal by wound area is roughly as follows, if no particular complications occur, but it may vary depending on the patient’s condition and the state of the wound.

Frequently Asked Questions

1. I want suturing by a plastic surgeon.

As interest in cosmetic appearance has increased, many patients want suturing by a plastic surgeon. In general, it can be said that plastic surgeons suture in a better way, but they do not use special instruments only they have or perform a special suturing technique, and it is still impossible to suture a wound so that there is absolutely no scar at all. Going from hospital to hospital to receive suturing from a plastic surgeon, or delaying suturing and waiting, can miss the proper treatment window and harm wound healing.

2. If I get a wound, can I apply household soybean paste or powdered medicine?

Applying ointments or powdered medications that are easily available on the market to a laceration to stop bleeding not only does not help stop bleeding, but may also interfere with drainage from the wound and make it harder to remove contaminants stuck to the wound. Applying soybean paste is also not good. The wound should be washed with running tap water so that as little dirt or other contaminants as possible remain in the wound. If there is no tap water nearby, drinking water can be used for cleaning.

3. What should I do if the bleeding does not stop even when I keep pressing on it?

If the blood from the wound changes with the heartbeat or spurts out, it is likely arterial bleeding. If bleeding does not stop even after applying pressure for more than 10 minutes, call 119 immediately and receive treatment from medical staff. At this time, removing the gauze covering the wound to check whether the bleeding has stopped may stimulate a barely controlled wound and cause bleeding again, so it is better to keep adding more gauze and pressing while waiting for medical staff.

4. I heard that you must get a tetanus shot after an injury.

When a wound occurs, it is necessary to prevent tetanus through proper measures such as disinfecting the wound and cutting away already dead tissue. Check whether you have had tetanus vaccination in the past, and if it is judged to be insufficient, a tetanus immunoglobulin injection or tetanus vaccination is needed. Even if you are not injured, it is good to keep up with tetanus vaccination every 10 years. Because tetanus is a disease caused by toxins, using antibiotics is not a preventive measure.

So far, this has explained the treatment of lacerations.

In the next installment, we will look at color vision abnormalities (color blindness).

Source: Korea Disease Control and Prevention Agency National Health Information Portal