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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 nearby skin.
     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.

benzalk.jpg (19595 bytes) 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.

When you 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.

bf-buttr.jpg (6287 bytes)

bf-steri.jpg (7672 bytes) 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.

lac1c.jpg (14954 bytes) The wound has been cleaned. Benzoin has been placed and allowed to dry completely. Now a Steri-Strip has been placed.

Steri-Strips or 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.

lac1d.jpg (18197 bytes)

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.

Watch for:
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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