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Lacerations

Specialties > Emergency medicine and intensive care

Epidemiology

Epidemiology

  • Lacerations are common injuries seen in emergency departments, accounting for a significant number of visits annually.
  • Most lacerations result from blunt or sharp trauma, with a higher incidence in young adults and children.
  • Workplace injuries, particularly in manual labor and construction, contribute to a significant proportion of lacerations.
  • Sports-related activities are also a common cause, especially in contact sports.

Differential Diagnosis Schema 🧠

Traumatic Causes

  • Abrasion: Superficial scraping of the skin without full-thickness skin loss.
  • Incision: Clean, straight-edged wound typically caused by a sharp object like a knife.
  • Puncture wound: A deep, narrow injury caused by a pointed object, such as a nail or needle.
  • Avulsion: A forceful tearing away of tissue, leading to a flap or complete loss of skin.
  • Crush injury: Results from an object causing high pressure to a body part, potentially leading to tissue damage beyond the laceration.
  • Bite wound: Lacerations caused by animal or human bites, which carry a high risk of infection.
  • Degloving injury: A severe form of avulsion where the skin is peeled away from underlying structures.

Non-Traumatic Causes

  • Pathological fractures: In patients with osteomyelitis or cancer, minor trauma can cause significant lacerations.
  • Skin disorders: Conditions like epidermolysis bullosa can cause skin to tear easily, resulting in lacerations.
  • Nutritional deficiencies: Severe vitamin C deficiency (scurvy) can lead to fragile skin, predisposing to lacerations.
  • Chronic steroid use: Leads to skin thinning and increased risk of lacerations from minor trauma.

Key Points in History 🥼

Background

  • Mechanism of Injury: Determine the cause (e.g., sharp object, blunt trauma) to assess the extent of damage.
  • Time of Injury: Older wounds are more likely to be infected and may require different management.
  • Contamination: Assess for the presence of foreign bodies, dirt, or animal bites, which increase infection risk.
  • Bleeding: Note the amount and duration of bleeding to assess for potential vascular injury.
  • Tetanus Immunization Status: Important for wound management and prophylaxis.
  • Medical History: Consider factors like diabetes, immunosuppression, or vascular disease that may affect healing.
  • Drug History: Identify any anticoagulants or antiplatelet medications that could exacerbate bleeding.
  • Social History: Occupation and hobbies can provide context for injury and potential complications.
  • Previous Wound Healing Issues: History of keloid formation, hypertrophic scars, or poor wound healing.
  • Allergies: Important for selecting appropriate sutures, dressings, and antibiotics.
  • Pain Level: Assess pain to guide analgesia and management.

Possible Investigations 🌡️

Clinical Examination

  • Visual Inspection: Assess the wound size, depth, and any signs of infection (redness, swelling, pus).
  • Palpation: Check for tenderness, foreign bodies, or underlying fractures.
  • Neurovascular Assessment: Examine distal pulses, capillary refill, and sensation to rule out nerve or vessel injury.
  • Range of Motion: Evaluate if the laceration affects joint function, particularly if near a joint.
  • Photographic Documentation: Consider taking photos for medical records, especially for medico-legal purposes.

Imaging

  • X-ray: Useful to detect foreign bodies (e.g., glass, metal) or associated fractures.
  • Ultrasound: Can be used to locate soft tissue foreign bodies or assess deeper tissue involvement.
  • CT Scan: Consider if complex injury or suspicion of significant underlying damage, especially in the head or torso.

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Emergency medicine and intensive care