Minor Laceration Pictures
I can't remember the mechanisms of injury because these pictures are from a while back, but these are examples of various types of simple lacerations that require repair. I'm a fan of steri-strips or Dermabond in many circumstances, but some wounds are more appropriately sutured.
This first laceration was not under tension and was easily closed with steri-strips, a relatively underutilized technique in my opinion. Note the spacing of the strips and the cross-hatched application to keep them secured. Tincture of benzoin is applied to the surrounding skin prior to placement of the strips; the stickiness prevents them from falling off too soon. Be sure to apply the benzoin all the way up to the wound edges to aid in their approximation, but try not to get it into the wound itself, particularly in children. It burns like heck but doesn't harm the wound as far as I know....benzoin is also an antiseptic.
This arrowhead-shaped laceration was a bit trickier, as it was under tension and therefore tended to gape. A corner stitch was placed first at the tip, then the edges were sutured. I pull all of the knots to one side of the wound to make it look neater.
Skin tears in the elderly are common, and their fragile skin does not tolerate sutures well. I formerly used steri-strips on these injuries, but now I almost always use Dermabond. I always infiltrate the base of the wound (not the flap) with a little lidocaine with epinephrine to allow me to clean it more aggressively and to reduce the possibility of hematoma formation. This technique is quick, easy, relatively painless, and effective.
This first laceration was not under tension and was easily closed with steri-strips, a relatively underutilized technique in my opinion. Note the spacing of the strips and the cross-hatched application to keep them secured. Tincture of benzoin is applied to the surrounding skin prior to placement of the strips; the stickiness prevents them from falling off too soon. Be sure to apply the benzoin all the way up to the wound edges to aid in their approximation, but try not to get it into the wound itself, particularly in children. It burns like heck but doesn't harm the wound as far as I know....benzoin is also an antiseptic.
This arrowhead-shaped laceration was a bit trickier, as it was under tension and therefore tended to gape. A corner stitch was placed first at the tip, then the edges were sutured. I pull all of the knots to one side of the wound to make it look neater.
Skin tears in the elderly are common, and their fragile skin does not tolerate sutures well. I formerly used steri-strips on these injuries, but now I almost always use Dermabond. I always infiltrate the base of the wound (not the flap) with a little lidocaine with epinephrine to allow me to clean it more aggressively and to reduce the possibility of hematoma formation. This technique is quick, easy, relatively painless, and effective.
Labels: ER, lacerations, medical, pictures
posted by scalpel at 7:28 PM
19 Comments:
i like the cross-hatch steri strip technique. mind if i steal it from you?
Not at all. That's why I posted it.
say, have you noticed that your moonbat robot is down. i took it off my site b/c it would no longer rant. any ideas?
Mine works for me. Maybe try to install an updated flash player?
hmmm. won't work on a variety of computers i try but i bet you are right. like the robot. gotta get him back. enjoying our fisticuffs with shadowfax btw.
You don't need a robot as long as lyle and jimii are around.
I've decided to only read Shadowfax for strictly ER posts. It's a borderline The Speaker situation over there. The 'universal health' plan he's advocating calls for abolishment of employer insurance, a raise equal to the amount the company paid for health insurance on your behalf in 2006, and government subsidies for everyone at 400% of the poverty level. So, in essence, your raise would go to subsidizing nearly everyone in the country and you'd have to pay for your insurance yourself too. I'm about 3K/yr over 400% of the poverty level, so I'd get no subsidies, I'd have to buy insurance that doesn't weed out those with costly medical problems (since insurance couldn't exclude anyone), and markedly higher taxes. SIGN ME UP!
Notice he called you a member of "The Flat Earth" crowd, 911?
You know my test tomorrow is covering types of wounds in pathology tomorrow...thanks for the visual refresher
The before pictures were icky, but necessary. The after ones really look good. Too bad you couldn't get healed pics too to complete the cycle.
I too am planning to steal your basket-woven steri-strips idea -
Functional and yet and pretty darn cool looking!
I am a PGY 2 intern in ED - such tips are gold! more please!.
Good post, good pictures. In my community, sutures placed by ER docs were removed by us, the surgeon on call the day the patient had been seen. So I particularly like the fact that your sutures are widely placed, and the bites are big enough to be removed easily. Lots of docs seem to like using a million tiny 6-0 sutures...
The more wounds that can be steri-stripped, the better. For what it's worth, I think there are considerably fewer skin reactions (not common, but can be bad when they occur) to mastizol (sp?) than to benzoin.
When feasible, if I'm working on a day when it would be appropriate, I try to have my patients return to the ER so I can remove their sutures myself.
I generally like to get the sutures out a bit early and then stabilize the wound with steri-strips.
Of course it's not always possible for one reason or another, but it is beneficial for continuity of care and personal feedback reasons. If they come in right at the beginning of a shift, I'll take care of them in triage before I do anything else.
Hello! I need some advice, please. Although a ENT resident myself, I am also a patient, and a very paranoic one... I have a wound in the temporo-orbicular area, that has been steri-stripped, but don't know if I should leave it to breathe or to cover it. It is quite moist. I must say that, being a girl, I am thrice as paranoic. And my experience of skin wounds is limited to the retroauricular sutured ones. Are betadine and air enough?
Helen
Also, benzoin smells great. Nothing like the smell of baked goods to calm a patient down, I'd imagine.
such a simple and reassuring explanation of a few techniques! I'm starting out as an intern next year, and info like this is gold.... I hope you don't mind, I have linked to it in my blog..
http://stewy6.com/synapse
Scalpel,
I'm teaching a class on suture-free wound closure to a group of paramedics and wilderness EMTs and was wondering if you would mind if I used your picture of the "cross-hatch steri strip" technique in my lecture.
Thanks, keep up the good work!
Wooten
Be my guest.
Hi,
I'm a wound CNC in Victoria, Australia, and am preparing a very basic net based elearning resource for staff. I'd like to use these photos as examples of 'skin tears' that should be seen by a doctor. Of course, I'll credit you as owner of the photo.
Lisa Hewitt
Post a Comment
<< Home