This page provides clinical guidance on skin lacerations and incisional wounds for health professionals.
The following information about skin lacerations and incisional wounds is taken from 3D Regional HealthPathways, accessed June 2020:
• Ask about the injury.
◊ an inflicted (non-accidental) injury.
◊ factors that may affect healing.
◊ tetanus immunisation status.
- Examination – Check:
• the wound.
• muscle and tendon structures for visible deficits, range of motion, and motor strength and stability.
• nerve structures for motor strength and sensation.
• vascular structures for distal circulation, including capillary filling, temperature, and colour.
• the underlying bone and joint structures.
• If a radiopaque foreign body (e.g., glass, metal) or underlying bone damage is suspected, consider arranging an X-ray.
• If a radiolucent foreign body is suspected (e.g., wood, vegetation), consider arranging an ultrasound.
- If suspected critical limb ischaemia i.e., rest pain and/or tissue loss with absent pulses, request acute vascular surgery assessment.
- Decide whether there are any other indications for specialist management or discussion:
• If the wound involves the face or upper limb distal to the elbow, request acute plastic surgery assessment or seek plastic surgery advice.
• If suspected joint or bone involvement other than the face or upper limb distal to the elbow, request acute orthopaedic assessment or seek orthopaedic advice.
• Otherwise, request assessment based on whether the wound is likely to require soft tissue debridement, reconstruction, or a skin graft:
◊ If the wound is likely to require significant soft tissue debridement, reconstruction, or a skin graft, request acute plastic surgery assessment or seek plastic surgery advice.
◊ If not, request emergency department assessment or seek emergency department advice.
- Assess for any contraindications to primary closure of the wound. If contraindicated, consider:
• delaying primary closure.
• healing by secondary intention.
• requesting specialist management or advice as above.
- Assemble the required wound closure items.
- Provide appropriate and adequate pain relief, see:
• Analgesia in Adults with Acute Pain
• Analgesia in Children with Acute Pain
- Ensure good wound preparation.
- Obtain informed consent.
- Anaesthetise the wound area. If the patient is a child or has a needle phobia, consider alternatives to local anaesthetic injection.
- Clean the wound with saline or under running tap water.
• If dirty (e.g., animal bite), irrigate thoroughly. Consider using a topical antiseptic solution – see Wound Infections.
• Remove all foreign bodies with irrigation, forceps, or a brush e.g., cytobrush.
- Debride the wound and remove any devitalised tissue.
- Decide on the appropriate repair method:
• Tissue adhesive
• Tape closure
- Select the appropriate dressing materials.
- Splint wounds over joints and mobile areas, if possible.
- Provide tetanus-prone wound management, if indicated.
- Consider prophylactic antibiotics.
- Provide advice on self-care of the wound:
• Elevate a limb wound as much as possible.
• Keep the wound dry for the first 48 hours.
- Complete an Accident Compensation Corporation (ACC) form.
- Arrange review in 1 or 2 days:
• If symptoms or signs of infection, follow the Wound Infections pathway.
• Remove sutures as soon as practically possible, according to the location of wound. Usually, remove sutures in:
◊ 5 to 7 days for facial wounds. Consider at 3 to 5 days, then replace with glue or Steristrips depending upon the site.
◊ 7 to 10 days for trunk and limb wounds (7 days only if there is no tension).
◊ 10 to 14 days for tensioned areas or wounds over joints.
• After suture removal, tape the wound for a further week, unless this is completely impractical.
Consensus document: Surgical wound dehiscence – improving prevention and outcomes Wounds International
- Skin lacerations and incisional wounds 3D Regional HealthPathways, NZ, 2020