Stitches (cont.)
How does the health-care provider assess a wound?
Lacerations are common injuries that are seen in physicians' offices and
emergency departments. The approach to the injury is often the same. The history
taken by the health-care provider is very important to decide whether the
benefit of repairing the wound outweighs the potential risk of complications,
most often infection. The provider will want to know the circumstances of the
injury.
- Where did the accident occur? Was it washing dishes in the sink, or did
it occur in a farm field, cleaning dirty equipment covered in mud?
- When did it
happen? The older the wound, the higher the potential for infection.
- Was it
due to a fall or other trauma so that other parts of the body might be damaged?
- Were there unusual circumstances, like an animal bite, or did it occur
underwater in a river or lake (both situations being at high risk for
infection)? One can imagine a variety of scenarios in which infection risk is
great.
Physical examination is key to making certain that underlying structures are
not damaged. This is especially important in the extremities where arteries,
nerves, and tendons run beneath the skin. When skin is damaged over a broken
bone, it is called an open fracture, and often patients with such a fracture are
taken to the operating room so that the wound can be extensively cleaned to
prevent osteomyelitis (an infection of the bone). This same situation may also
occur if the laceration goes deep into a joint.
X-rays may be taken, looking for foreign material that may be imbedded in the
laceration. While metal objects are easier to see, nonmetallic foreign objects
may also be identified.
Once the decision is made to repair the wound, the health-care provider has
many options: sutures, staples, glue, Steri-Strips, and Band-Aids. But first the
wound needs to be prepared for sewing (or suturing or stitching; the words all
describe the same procedure).
- Ideally, the injured area is exposed and cleaned with water, saline (salt
water), and/or soap.
- A local anesthetic is administered to allow full
exploration of the wound, looking for foreign objects or damage to underlying
structures.
- The wound may again be washed or irrigated to try to minimize the
risk of infection.
Next: How is the type of closure material chosen? »
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