Otterness K, J Singer A. Updates in emergency department laceration management. Clin Exp Emerg Med. 2019;6(2):97-105.

Link to article

Journal Article Summary:

This article is a review of current recommendations in laceration management in the emergency department. I chose this article because of the laceration repair case (Focused H&P #8) as well as other lacerations I have recently participated in. I wanted to review up-to-date management and techniques of lacerations, as this is a common issue that is seen in emergency departments, and it is important to know how to manage lacerations effectively. As this article is from within the last five years and reviews recent studies in a succinct manner, I found it appropriate to summarize certain pertinent points.

On the topic of closure material, the article reports that a randomized controlled trial of 115 patients found no significant difference between using absorbable versus non-absorbable sutures on extremity and trunk lacerations in terms of complication and cosmetic outcomes. While further studies into this are warranted, it suggests that absorbable sutures may be implicated in other areas of the body instead of mainly on mucous membranes or in surgical procedures. When comparing sterile to nonsterile gloves, a randomized controlled study of lacerations in the emergency department found similar infection rates between sterile and nonsterile gloves, suggesting that nonsterile gloves are appropriate to use in the ED setting. Looking at irrigation techniques, castile soap and povidone-iodine solution were found to have higher rates of infection in comparison to normal saline in two separate studies. In the RCT that assessed povidone-iodine to normal saline with 444 ED patients, the rate of infection in the normal saline group was 5.8% in comparison to 8.7% in the povidone-iodine group. Evaluation of anesthesia is vital, as most laceration repairs use local anesthesia with subcutaneous injection, which is often painful to the patient. A review of 25 RCTs with over 3,000 patients found no complications as well as effective pain control when topical anesthetics were used, in comparison to local anesthesia. Some of the studies found that the topical anesthetics even had similar efficacy to the local anesthesia. More research into topical anesthetics, especially its use in conjunction with local anesthesia, is warranted. Of interest, there was a RCT of 90 patients receiving an ice pack to the laceration site prior to local anesthesia. Those who received an ice pack, in comparison to those who did not, reported lower pain scores both before and after injection. Lastly, it is interesting to note that in a retrospective cohort study with over 1,000 pediatric patients with facial lacerations, the patients with public insurance were less likely to have a consultation with a specialty in comparison to those with private insurance, even though the lacerations were similar in presentation and character.

While investigating many different aspects of laceration repair, this article provided thorough and thought-provoking reviews on how to handle lacerations in the emergency department setting. Continuously learning, understanding and adopting evidence-based findings can aid in providing proper laceration care.