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Today I reviewed the cookie cutter post-laceration care instructions my hospital uses.  Let’s just say they leave a little to be desired.  Below I’ve re-designed the instructions, incorporating information that makes sense and has at least some grounding in medical evidence, as discussed in my last post.  They are written in plain-speak for your patients.  Feel free to copy, edit, share, and link your patients directly to these instructions.

Your Laceration Aftercare Instructions

A laceration, or cut, is an open wound through the skin.  These can be due to many different causes and can come in many different forms.  The depth, location, and cause of your wound, among multiple other factors (including your preference) effect the treatment choices we made today.

At the very least today, we’ve cleaned, assessed and dressed your wound.

Additional care you need depends on the type of cut or wound you have. I may have used stitches, staples, tape (like “steri-strips”), or skin glue (like “dermabond”) to close the wound. The main purposes of these treatments are to stop the bleeding, and to help the wound heal with reduced scarring.

How can you care for yourself at home?

Keep the wound clean and dry for the first 12-24 hours.  The wound has probably had a bandage applied (unless skin glue was used, or if the wound was in a hard-to-bandage area, like your hair).  You can remove the bandage after 12-24 hours at your convenience.  After this, no further dressings are necessary, unless I advised you differently today.

Dressing a Laceration
Example of dressing a laceration after repair. Image courtesy of WikiHow, under Creative Commons Liscence (http://creativecommons.org/licenses/by-nc-sa/3.0/).

If your wound was sutured or stapled:

You can clean the area with a mild soap and water 2 times a day. Don’t use hydrogen peroxide, iodine-based solutions, or alcohol, which can slow healing, and will probably be painful!

You may cover the wound with a thin layer of antibiotic ointment, such as bacitracin or neosporin.  Be advised that some people can develop allergic skin rashes to topical antibiotics, especially neomycin (a component of neosporin) so you should avoid this if you have a known sensitivity.  You can continue to apply the antibiotic twice daily until the wound scars and dries out, or the sutures/staples are removed.

Sutures and staples should be removed within 3 days to 2 weeks, depending on where on your body they are located.  One exception is if absorbable sutures were used–these sometimes don’t require a visit for removal–I’ll advise you if this was the case.  The general rules of thumb for suture removal are as follows:

Optimal time frame for suture removal
Location
Face
Scalp
Chest and extremities
High tension areas (joints, hands)
Back
Number of days
3–5
7
8–10
10-14
10–14

Keep in mind, specific situations related to your wound as well as your other medical conditions play in to the optimal removal time–this is just a guideline!

If your skin was glued:

Skin adhesive glues such as Dermabond are sometimes used instead of stitches to close cuts. When the adhesive dries, it forms a film that holds the edges of the cut together. Skin adhesives are sometimes called “liquid stitches.”

Typically, I don’t place bandages over a wound closed with tissue adhesive glue–you can think of the glue as a dressing in and of itself.  Also, contrary to other wound closure techniques, in which I recommend use of antibiotic ointment to create a moist, clean healing environment, I recommend against this when using skin glues.  This is because creams and ointments can cause the glue to prematurely slough off.

You may have some swelling, color changes, and bloody crusting on or around the wound for 2 or 3 days. This can be normal, and doesn’t mean the glue isn’t working.  The glue will naturally slough off in about 5-7 days. At this time, scar tissue will be forming under the surface of the wound and your body will do the rest of the work of healing.

Some other important points are:

  • Do not scratch, rub, or pick at the adhesive.
  • Do not put tape directly over the adhesive.
  • You can shower with a skin adhesive in place, but do not soak the area in water. Do not go swimming. Be sure to gently dry the area after it gets wet.

If your hair strands were glued (hair apposition):

Sometimes, I use your own hair strands twisted and glued to bring the edges of a scalp laceration together.  The advantage of this is that you won’t have to come back to have stitches or staples removed.  Please try to keep the area clean and dry and avoid shampoos or hair products on the area which can cause the glue to come loose prematurely.  The glue will naturally dissolve in about 5 days, after which time your hair strands will unravel.

If your wound was closed with tape:

Tape strips have the advantage of being less painful to apply and lower risk of infection, but do require more caution on your part, as they are more fragile than other skin closure techniques.  It’s important to

  • keep the tape clean and dry
  • avoid picking at the tape or rubbing the area
  • avoid soaking in water (showering is okay–bathing is not)

The tape strips will fall off on their own in about 5-7 days (if they don’t, you can gently remove them or soak the wound in water at this time to loosen them).  At this time, scar tissue will be forming under the surface of the wound and your body will do the rest of the work of healing.

If your cut was left open:

Many cuts I see I actually advise leaving open.  This can be for several reasons, but often is because

  • the risk of infection is too high to primarily close the wound (many reasons for this)
  • the scar that is expected without closure is cosmetically acceptable to you

This is fine, and in many cases, advisable.  If you would like to see some examples of wounds that have healed well without primary closure, link here.  In certain rare situations, we may devise a plan in which you will return at a later time to have the wound closed with stitches, once we are sure no infection is developing.  This is a strategy we call “delayed primary closure.”

In this case, my recommendations for aftercare are simply to keep the area clean, use topical antibiotic ointment twice daily until the wound dries out, and follow up for signs of infection, as noted below.

After your stitches/staples/glue/tape come off:

It’s very important to recognize that the most vulnerable time for a wound are the days right after the closure material has been removed.  This is when a wound is most susceptible to dehiscence (opening up).  Thus, be careful to avoid activities that could put your wound under unneccesary and excessive tension forces.

Any wound that passes through the full thickness of the skin will cause a permanent scar.  This scar may be very prominent at first, but tends to gradually improve over the course of about a year. Protect your healing wound from excessive sunlight, which can darken the final appearance of a scar.  If a year has passed, and you are still not satisfied with the appearance of the scar, you can contact a plastic surgeon to discuss scar revision.

When should you call for help?

Call your doctor now, or seek immediate medical care in an emergency department if:

  • Your wound is causing new pain, or the pain gets worse.  Some pain is normal with a wound, but do not ignore pain that is getting worse instead of better. You could have an infection.
  • The cut starts to bleed, and blood soaks through the bandage. Oozing small amounts of blood is normal.
  • The skin near the cut is cold or pale or changes color.
  • You have tingling, weakness, or numbness near the cut that we did not address during your visit.
  • You have trouble moving the area near the cut that we did not address during the visit.
  • You have increased pain, swelling, warmth, or redness around the cut, which could be a sign of infection.
  • There are red streaks leading from the cut, or there is pus draining from the cut.
  • You have a fever that you can’t explain for another reason (like having a common cold).

What else do I need to know/do?

Being treated in the emergency room is only one step in your treatment. Even if you feel better, you still need to go to all suggested follow-up appointments and take medicines exactly as directed. This will help you recover and help prevent future problems.

Follow-up care is a key part of your treatment and safety.

Be sure to make and go to all appointments, and call your doctor if things are not going as expected.

If you’ve been prescribed antibiotics, take them as directed.  Do not stop taking them just because you feel better. If you don’t finish the course, you can breed resistant infections, which are harder to treat!

Take good care of your wound at home to help it heal quickly and reduce your chance of infection. While your wound is healing, avoid any activity that could cause your wound to reopen.  Use common sense when it comes to activities.  Also, avoid unnescessary, copious bacteria exposure–for example, swimming in an ocean or hot tub, or wearing shoes or gloves over a wound for a long period of time (which promotes bacterial growth).

Take care and be patient!  Wound healing takes time, and it will be a while until you get to see the final results. I am confident with the care we’ve provided, your wound will look as good as possible.

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