Layered closure of lacerations

The cause, depth, and location of a laceration are major determining factors in its treatment. In all cases, the wound must be completely cleansed with irrigation under pressure and then examined radiographically if necessary and debrided. Successful repair depends on understanding and using the principles of wound healing. The skin's greatest strength is in the dermal layer, and the best repair results when the entire depth of the dermis is accurately approximated to the entire depth of the opposite dermis. Accurate coaptation of the epidermis gives a polished effect to the repair but does not contribute to its strength. Fat and muscle do not support sutures. Full-thickness sutures may safely be used only on palmar and plantar surfaces. With an extensive laceration or one near a joint, a splint or sling may be needed. The wound should be examined a couple of days after suture placement for signs of infection.