I.

Definitions

Laceration, deep cut or tearing of the skin that results in an irregular wound. This type of wound is often
irregular and jagged. Lacerations may be caused by injury with a sharp object or by impact injury from a
blunt object or force.

II. Overwiew of the system invloved

The system involved in lacerated woundn is integumentary system specifically skin. A laceration is a
wound that is produced by the tearing of soft body tissue. They may occur anywhere on the body. In
most cases, tissue injury is minimal, and infections are uncommon. However, severe lacerations may
extend through the full thickness of the skin and into subcutaneous tissues, including underlying muscle,
internal organs, or bone. Severe lacerations often are accompanied by significant bleeding and pain.

III. Causes and Risk factors

Lacerations caused by the following incidents:

Blunt trauma – refers mostly to injuries resulting from a physical attack or an impact from an object (big
or small). A good example is a physical confrontation where punches were thrown and they land on
different parts of the body, resulting in cuts and split lips. Blunt trauma can also be caused by a major
blow to any part of the body, like being hit by a baseball bat. A collision has the heaviest impact and is
another blunt trauma that causes lacerations.

Childbirth – A perineal tear is an unintended laceration of the skin in the perineum, the region where
the vagina and the anus are found. This laceration occurs in vaginal childbirth and could be mild or
severe.

Fall – There are two ways where a fall can cause lacerations. One, it can result from a fall when the
person gets cut on the way down, like when he’s falling from a tree and he hits several branches before
he reaches the ground. Two, a person may get a laceration when he hits the ground, like in the case of
falling from a bike and he scrapes his knees or legs or palms.

Sharp-edged objects – Sharp-edged objects are the most common causes of lacerations because it’s
easy to get cut from them, especially knives, scissors and glass.

Risk Factors

Certain risk factors may lead to chronic wounds, such as: Malnutrition and diet ,Circulation problems,
Infection, Aging, Diabetes, Hyperglycemia – especially blood sugars over 150, Arthritis, Kidney disease,
Certain medications, Swelling, Weight, Smoking and Inability to adhere to individual plan of care.

IV. Complications

Bacterial infection of wound can impede the healing process and lead to life-threatening complications.
Wounds that are not healing should be investigated to find the causes; many microbiological agents may
be responsible. The basic workup includes evaluating the wound ,its extent and severity. Cultures are
usually obtained both from the wound site and blood. You may have an infection if the wound shows: an
increase in drainage, thick green, yellow, or brown pus, pus with a foul odor, a fever of over 100.4°F
(38°C) for more than four hours and a wound that isn’t healing. X-rays are obtained and a tetanus shot
may be administered if there is any doubt about prior vaccination.

Chronic or Non-healing wounds of persons are considered one of the most significant complications of
diabetes. Associated with inadequate circulation, poorly functioning veins, non-healing wounds occur
most frequently in the elderly and in people with diabetes.

V. Pathophysiology

To heal a wound, the body undertakes a series of actions collectively known as the wound healing
process.

VI. Management

Medical Management

The overall treatment depends on the type, cause, and depth of the wound, and whether other
structures beyond the skin (dermis) are involved. Treatment of recent lacerations involves examining,
cleaning, and closing the wound.

Cleaning

Evidence to support the cleaning of wounds before closure is scant. For simple lacerations, cleaning can
be accomplished using a number of different solutions, including tap water and sterile saline solution.
Infection rates may be lower with the use of tap water in regions where water quality is high.

Closure

If a person presents to a healthcare center within 6 hours of a laceration they are typically closed
immediately after evaluating and cleaning the wound. After this point in time, however, there is a
theoretical concern of increased risks of infection if closed immediately. Thus some healthcare providers
may delay closure while others may be willing to immediately close up to 24 hours after the injury. Using
clean non-sterile gloves is equivalent to using sterile gloves during wound closure.

If closure of a wound is decided upon a number of techniques can be used. These include bandages, a
cyanoacrylate glue, staples, and sutures. Absorbable sutures have the benefit over non absorbable
sutures of not requiring removal. They are often preferred in children.Buffering the pH of lidocaine
makes the injection less painful. Adhesive glue and sutures have comparable cosmetic outcomes for
minor lacerations <5 cm in adults and children. The use of adhesive glue involves considerably less time
for the doctor and less pain for the person. The wound opens at a slightly higher rate but there is less
redness. The risk for infections (1.1%) is the same for both. Adhesive glue should not be used in areas of
high tension or repetitive movements, such as joints or the posterior trunk.

Dressings

In the case of clean surgical wounds, there is no evidence that the use of topical antibiotics reduces
infection rates in comparison with non-antibiotic ointment or no ointment at all. Antibiotic ointments
can irritate the skin, slow healing, and greatly increase the risk of developing contact dermatitis and
antibiotic resistance. Because of this, they should only be used when a person shows signs of infection
and not as a preventative.

The effectiveness of dressings and creams containing silver to prevent infection or improve healing is
not currently supported by evidence.

Nursing management

Assessment: Determine the etiology, assess the characteristics of wound, including color, size, drainage,
odor and severity of laceration. (Scalp and facial lacerations often bleed profusely because of the high
vascularity of these are direct pressure over the wound is usually sufficient to control).

Apply a dressing: Protective dressing must be applied to the lacerated wound. First applying a thin layer
of antibacterial oinment or gauze impregnated with petrolatum or other occlussive subtsance. Then dry,
sterile gauze is applied for padding, followed by a wrap of woven gauze. Adhesive tape is used to hold
the dressing in place.