Laceration refers to a jagged or torn wound caused by sharp objects that cut through the skin, separating the connective tissue elements. It is quite different from abrasion since no part of the skin is missing, just separated. A deep laceration may reveal underlying tissues such as the tendons, bone, muscle or fat. They are usually caused by traumatic events such as accidents, falls, hitting a sharp object and sport-related injuries. Regardless of how your laceration occurred, it is important to clean it as soon as possible to avoid excessive bleeding or bacterial infection.
Signs of Lacerations and Cuts
Most lacerations are easy to detect since they make themselves obvious both symptomatically and visually. Apart from seeing the cut, other symptoms include pain, bleeding, skin discoloration, swelling, and bruising. The pain may range from mild to severe and usually depends on the level or seriousness of the injury. For extreme lacerations, you may experience blood spurting out of the wound or bleeding that cannot be stopped. Other people may suffer neurological reactions such as fainting at the sight of their own blood. They can also exhibit signs of shock such as rapid breathing, clammy skin, and a weak pulse.
Evaluation and Diagnosis of a Laceration
The sequential steps in evaluation of a laceration include finding and treating the injuries, obtaining hemostasis and checking for any signs of damage to underlying structures. Wounds that are actively bleeding may require hemostasis before evaluation. Direct pressure and topical anesthetics may be used to reduce bleeding.
The wound needs to be checked for signs of damage to underlying structures. This includes the joints, vessels, tendons, nerves, and the presence of foreign bodies. Failure to address these issues may lead to severe complications in the body previously diagnosed as a ‘minor cut’. Some of the injuries that need to be evaluated include:
- Tendon Injury
Complete tendon laceration causes a deformity in resting because of unopposed forces from the antagonist muscles. The injured area needs to be examined to assess the full range of motion since it may not be visible if it is in the resting position. The tendon injuries can also be identified using point-of-care ultrasound.
- Nerve Injury
The examination of a nerve injury is suggested by a motor abnormality or sensory distal to the wound. The medical examiner will test both motor function and a light touch to determine the extent of your nerve injury.
- Bone and Vascular Injury
A bone injury is possible if it occurs over a bony prominence or after blunt trauma. Signs of vascular injury include decreased pulses, pallor, and delayed capillary refill. It usually occurs when a laceration results from penetrating trauma or traverses the territory of a major artery in the body.
- Joint Penetration
It usually involves penetrating trauma and occurs when you have deep wounds near a joint. Normal saline can be injected in the joint under sterile conditions when in doubt.
- Foreign Bodies
Sometimes the object the cut through the skin can inject foreign bodies into the wound. Some good examples include lacerations caused by sharp metals or glass. When a patient complains about a feeling of a foreign body inside the wound, it should not be ignored, as it can result in serious complications.
How is it Treated?
Treatment involves cleansing and local anesthesia, exploration, debridement, and closure. The wound and the skin surrounding the affected area needs to be cleaned properly. It should not be exposed to vigorous scrubbing and harsh substances since the sub-epidermal tissue is relatively delicate. Although injectable local anesthetics are used, topical anesthetics can also be beneficial for wounds of the face or scalp.
Regional nerve blocks cause less distortion to the wound and are sometimes preferred to wound injection. The use of topical anesthesia is painless and makes injection unnecessary. The full extent of the wound is then explored for any possible tendon injury and signs of foreign materials. Contaminated puncture wounds need to be extended for adequate exploration and cleansing.
Debridement of lacerations involves the use of scissors or scalpel to remove devitalized or dead tissues before the wounds can be closed. The decision to close a wound may vary depending on the cause of injury, the degree of contamination, its age, patient risk factors, and the wound’s location.
Most bleeding after deep lacerations can be stopped with direct pressure applied to the affected area. Cleaning the wound helps minimize the chances of bacterial infection. It is important to seek immediate medical attention so that the laceration can be treated and closed to avoid further complications.