Large lacerations can take your breath away. Sometimes, something that looks complex and ghastly is rather simple if you take the surrounding blood and exposed underlying tissue out of the picture. First thing to do when approaching a large wound is to take a deep breath, you got this! The last thing the patient needs is someone with a deer in the headlights look…
If significant trauma was involved, don’t get distracted by the wound. Always approach the patient with the ABCDEs of trauma. You can cover the wound with a pressure dressing while the important things are evaluated. When its time to evaluate the wound, have some wet and dry gauze with you to clear the field and be able to better assess what is going on. Once stable you can get a better idea of the wound and start preparing for what you will need for repair.
Anesthetize, clean/irrigate, and visualize. Keep anatomy in mind and think about what structures are in the area to help guide you in looking for associated injuries to nerves, vessels, ligaments, tendons, and bone. Image if appropriate.
Gather your materials, map out a plan for the repair in your head or on paper, and get started…
Join me in The Laceration Course: https://www.ebmedicine.net/tlc
Dr. Patrick O’Malley
The Laceration Course, Course Director
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