Basic laceration repair

Question 1

Laceration repair indications

Answer 1

reduces infection, scarring and patient discomfort

Question 2

Methods of wound closure

Answer 2

staples- rapid placement, but do not allow for the meticulous wound-edge approximation
Suturing- most common
Adhesives- less painful and more quickly applied, useful for superficial lacerations that are not subject to large degrees of tension

Question 3

Contraindications to primary closure

Answer 3

delays in repair may increase the risk of infection

The location of the wound and the degree of contamination may affect the acceptable interval between injury and repair

Question 4

secondary closure should be strongly considered in wounds

Answer 4

that are grossly contaminated and for most puncture and bite wounds to the extremities

Question 5

Consultation with a specialist should be considered

Answer 5

for wounds involving substantial loss or destruction of tissue, complicated lacerations on the hands or face, or wounds thought to involve serious injury to an underlying structure

Question 6

The addition of epinephrine to the anesthetic

Answer 6

extends the duration of action, reduces bleeding, increases the amount of anesthetic that can be used, and increases the intensity of the block produced

Question 7

Solutions with epinephrine should be avoided in

Answer 7

areas with a single blood supply, such as the nose, pinna of the ear, and penis

Question 8

Sutures appropriate for facial lacerations

Answer 8

6.0 sutures

Question 9

sutures used on the torso, arms, legs, hands and feet

Answer 9

3.0, 4.0, 5.0 sutures

Question 10

1% lidocaine duration of action

Answer 10

30 minutes

Question 11

1% lidocaine with epinephrine

Answer 11

60-240 minutes

Question 12

0.25% Bupivacaine

Answer 12

240-480 minutes

Question 13

Timing of suture removal for facial wounds

Answer 13

within 5 days to prevent scarring

Question 14

Timing of suture removal for wounds of the scalp, torso, arms, legs, hands or feet

Answer 14

within 7-10 days

Question 15

Timing of suture removal for wounds under tension such as overlying joints

Answer 15

within 10-14 days

Question 16

Laceration repair complications

Answer 16

infection, wound dehiscence, retained foreign body, unrecognized deep structure injury and scar formation

Question 17

What are the three different anesthetics for suturing

Answer 17

1% lidocaine, 1% lidocaine with epinephrine, 0.25% bupivacaine

Question 18

In what time frame can you safely repair a scalp laceration

Answer 18

Facial or scalp lacerations can often be safely repaired more than 24 hours after injury

Question 19

What wounds is secondary closure necessary

Answer 19

Secondary closure should be strongly considered for wounds that are grossly contaminated and for most puncture, bite wounds to the extremities

Question 20

What type of sutures are used with percutaneous stitches

Answer 20

non absorbable monofilament nylon or polypropylene

Question 21

How many mg/ml of 1% lidocaine

Answer 21

10 mg/ml

Question 22

What is the maximum dose of 1% lidocaine per kg

Answer 22

4.5 mg/kg

Question 23

What is the larger suture size? What is the smaller suture size?

Answer 23

6. 0 smaller

3. 0 larger