complex lip laceration
Complex lacerations are life-threatening cuts with jagged edges that extend into deeper layers of tissues and are accompanied by heavy bleeding.

Lacerations, also called cuts, are wounds caused by tearing or cutting of open soft tissue (usually skin or muscle) due to trauma.

These types of wounds can be:

  • Deep or shallow
  • Long or short
  • Wide or narrow

Lacerations are simple to identify because they all involve injury to the epidermis (first layer of skin). The injuries can be mild or severe depending on the depth and extent of the injury.

Lacerations can be simple or complex, depending on variables, such as angle, force, depth, and object type.

  • Complex lacerations have jagged edges that extend into deeper layers of tissues and are accompanied by heavy bleeding.
  • These lacerations may necessitate several hours of layered closure, but the aesthetic results can be spectacular with proper technique.

The following are some of the most common causes of complex lacerations:

  • Machinery accidents in the workplace
  • Accidents involving automobiles and bicycles
  • Contact with a jagged-edged object
  • Falling or slamming on sharp objects
  • Mishaps when using scissors or knifes

Complex lacerations are life-threatening and necessitate medical attention right away. Patients who have blood oozing from wounds and have passed out as a result of blood loss should be taken to the emergency room.

When cuts occur in more dangerous areas of the body, such as the neck or where other arteries or major blood vessels are present, complex laceration repairs are required.

4 steps of complex laceration repair

  1. Clean and inspect the wound
    • Sterilize the area and anesthetize.
    • Regional anesthesia is almost always used.
    • Deep injury is ruled out by the doctor.
    • A doctor removes any foreign material if there is any.
  2. Repair the deep layer
    • Doctors begin laceration repair by repositioning the wound with deep sutures.
    • Temporary sutures can be used in some cases to relieve tension on the wound while deep layers are closed. As the wound heals, the temporary sutures are removed.
    • Doctors begin with the most profound layers of closure. Finally, absorbable long-lasting sutures are used to close the subcutaneous layer.
  3. Close the superficial layer
    • Doctors typically use interrupted sutures to approximate the skin's edges.
    • An antibiotic ointment, such as erythromycin, can be applied to the wound.
    • Wound dressings are not required in most situations.
  4. Healing process
    • Suture removal can be done 5 to 10 days after surgery. Within the first week or two, the wound heals superficially.
    • Scar maturation takes 6 to 12 months after surgery to occur.
    • During this time, patients must be supportive. Vitamin E oil can be used to massage patients. To reduce raised scars on the face, several brands of silicone sheeting are available.
    • Doctors will not perform any revision surgery until all healing has been completed and scars have flattened.

Stopping the patient's bleeding, cleaning out the wound, and closing the area to prevent further damage is part of complex laceration repairs.

Complex repair includes wounds that require more than layered closure, scar revision, muscle belly repair, and so on. Multiple layer closures of the face, ears, eyelids, nose, lips, and mucus membranes are examples.

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6 types of lacerations

Lacerations are splits or tears in the skin, mucus membranes, muscle, or internal organs. Lacerations are often caused by the application of a blunt force to a large area of the body, and they crush or stretch the tissues beyond their elasticity.

There are several types of lacerations, both simple and complex.

  1. Contused laceration:
    • The cut or injury in this type of laceration occurs in the tissues beneath the skin, leaving the skin intact but traumatizing the soft tissue.
    • When overlying tissues are forcibly and rapidly compressed against the bone by a blunt impact to any bony area of the body, a contusion is likely to occur.
    • Abraded laceration refers to a laceration with abraded margins.
  2. Split laceration: The skin splits when it is crushed between two hard objects, also called slit laceration.
  3. Incised laceration:
    • This type of laceration has very clean, sharp, wound edges with no tissue bridging or skin crushing.
    • People frequently misinterpret a slit or split laceration as an incised laceration wound, so a close examination is required.
  4. Stretch laceration:
    • Overstretching of the skin causes this type of laceration, which may cause the skin layer to protrude like a flap when the skin is fixed.
    • This type of laceration can be seen when a person runs over by a moving vehicle.
  5. Tear laceration:
    • When the skin comes into contact with and rubs against irregular or semi-sharp objects, such as a car door handle, tearing of skin and tissues can occur.
    • The tear in this laceration injury is deeper at the start than it is at the end.
  6. Cut lacerations: This is caused by a heavy and sharp-edged instrument, which crushes and stretches a large area of skin before splitting open in the center. The tissues bleed as a result of the trauma caused by the cut and tear.

Internal damage is possible in addition to a laceration on the skin and tissues, and this is more likely when the visceral organs are affected. It causes fatal bleeding; temporal arteries may bleed freely because they are unable to contract because of the damage.

Lacerations are always caused by an object striking the skin and tearing it. Though most minor lacerations do not necessitate a trip to the emergency room, deep lacerations and lacerations with extensive bleeding do necessitate immediate emergency medical attention.

The best way to avoid the most common types of lacerations is by exercising strong judgment in situations that are detrimental to one’s well-being.

5 side effects of not treating a laceration

The laceration, if left untreated and even if not treated immediately, causes certain side effects that may last for a shorter or longer period.

  1. Possibility of infection.
  2. Extensive scarring and contracture formation.
  3. This leads to more bleeding and hence, more blood loss. This can make a person weaker, even lower their immunity, and may prolong the healing process.
  4. Reduced range of movement of the affected part.
  5. If one tries to repair it themselves instead of consulting an expert, it may result in more damage due to inadequate wound closure.

Lacerations are a very common type of injury that is caused by skin cuts and tissue tears that sometimes go deeper than the skin itself and can penetrate the skin and even damage the tissues. If not treated promptly, it will cause further damage, so seek professional assistance.

If a minor laceration injury occurs, disinfect it immediately and ensure that it heals completely.

Because lacerations are so common, it is important to be aware of all the available treatment options.

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Medically Reviewed on 1/25/2022
References
Image Source: iStock Images

Forsch RT. Essentials of skin laceration repair. Am Fam Physician. 2008 Oct 15;78(8):945-51. https://www.aafp.org/afp/2008/1015/p945.html#

Starship. Lacerations and Wound Closure. https://starship.org.nz/guidelines/lacerations-and-wound-closure/

WikEM. Laceration repair. https://wikem.org/wiki/Laceration_repair

The Children’s Hospital of Philadelphia. Emergency Department Clinical Pathway for Evaluation/Treatment of Children with a Laceration. https://www.chop.edu/clinical-pathway/laceration-clinical-pathway