Wound repair

Wound & laceration repairs have been one of the most commonly requested topics for these urgent care summaries. How common our lacerations and/or some sort of wound repair in UC? We call it our “bread-and-butter” chief complaints. During the early months of the COVID19 pandemic, we had an increase of patients coming in for lacerations—newbies with even newer tools and hobbies? Yep! (only partially kidding and more of a joke aimed at my friend who sliced her finger whittling wood)
 
Disclaimer: I’ve decided to stay away from giving you suturing tips & suturing vids. While we all know that that’s one quick way to rack up a bunch of likes/views, there’s plenty of surgery PAs & surgeons who are doing those & better suited to give you tips--(insert basic suturing vid here)
 
 As always, thanks to HippoEd for these fabulous lectures which are just snippets of their Urgent Care bootcamp.  Their laceration/wound repair section has 16 videos to learn from! Learn more about UC bootcamp: here

I have two more summaries to go, let me know in the comments what you'd like me to review or if this has helped you in any way! 
 
Wound care

• Ensure irrigation of wound with copious amounts of sterile saline (simple tap water will do also)—this is ALWAYS documented in my note
• Ensure no foreign bodies 
• Keep wound moist & covered--as opposed to the age old rule of dry and open to air!
• In general, no need for topical/oral antibiotics if it is a clean wound
• If there is an infection or risk for infection—use oral antibiotics or topical mupirocin. Recommended to stay away from Neomycin due to allergic contact dermatitis
• Cover with dressing until wound healed or sutures are removed

 
When should I not close a laceration/wound?

•  Puncture wound
• Animal bites in extremities
• Human bites
• Grossly contaminated wounds
• If you have such case, you can consider delayed primary closure

 
What is delayed primary closure?
Clean/debride wound & place sterile dressing. Have patient return in 4-5 days to reassess wound and at that point in time, you can consider closing it!

Let’s talk anesthetics

• Think about using a small gauge needle when anesthetizing
• Buffering lidocaine with sodium bicarb decreases pain of the injection
• Cold anesthetics are painful! You want it at body temp or slightly warmer. I put the bottle in my pocket to warm it up before the procedure
• Most commonly used: lidocaine, lidocaine with epi, and bupivacaine
• Below is a summary of one of their tables

*note: anesthetics are available in concentrations other than those shown in table. Maximum allowable and maximum total volumes apply only to the specific concentrations in the table

​Skin glue

• Use: Superficial skin laceration repairs
• Avoid: high tension areas such as mobile joints (I’ve seen this done way too many times!)
• Ensure you start off with dry wound edges (after proper wound prep/cleansing)
• Oppose wound edges & apply skin glue
• Aftercare: inform pt he/she should not be adding topical antibiotic, petroleum jelly, or occlusive Band-Aid 

 
Skin tape

• Use: Simple straight superficial lacs—with little to no skin tension. Useful In elderly—especially with superficial skin tears and fragile/thin skin
• Avoid: joints & moist areas (axilla, groin, palms/soles, exudative wounds)
• Aftercare: Do not place occlusive dressing
• Leave skin tape on for 2 weeks. Pt can gently cleanse wound 1-2 days after initial placement of skin tape 
• Can I use skin tape & skin glue? YES! use skin tape to oppose wound edges and apply skin glue directly on laceration