Laceration Repair and Soft Tissue Surgery
Laceration repair is one of the most requested procedures for plastic surgeons and hand surgeons. The laceration repair is of more critical significance when the hands and face are involved because of the proximity to vital functional structures that have to be assessed and for cosmetic reasons.
Laceration repair management on the hand is the following:
- Proper examination is required not only of the laceration but the whole hand and upper extremity. The function of flexor tendons, extensor tendons must be evaluated to make sure they are not severed. If they are injured they will need to be repaired. The function of the median, musculocutaneous, ulnar and radial nerves must be assessed If they are injured they should be repaired with microsurgical technique. The bones must be evaluated next with X-Rays. The nails and nail beds must be examined and finally the rest of the patient to make sure no other bodily injuries have been incurred.
- Laceration repair can be performed in the emergency room or the operating room depending on the severity and extend of injury.
- The laceration must be irrigated well and washed out. Pressure irrigation is best for debridement of the tissues. The wound must be evaluated for any foreign body and debris. Any desiccated and devitalized tissue should be excised before the final laceration repair is completed because such necrotic tissue can serve as a nidus of infection.
- Laceration repair should finally proceed to closure after the wound has been thoroughly cleansed and debrided. Plastic surgery closure of the laceration repair is ideal. This entails closure of the tissues in layers. Bone, periosteum, fascia, muscle, tendon, nerve, blood vessels, subcutaneous tissue should be closed in separate layers with pertinent sutures.
- Laceration repair of the skin should be done in layers also. The subcutaneous supporting tissue should be approximated. The deeper dermis should be sutured with deep dermal sutures. The final skin closure can be done with subcuticular running suture or simple interrupted external sutures.
- Laceration repair will heal best if approximated with the least amount of possible tension.