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Laceration

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What is Laceration?

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While it is important to first define laceration, the laceration meaning can only be clearly understood with the layers of skin. A laceration is caused when the skin comes in contact with a sharp object or even through accidents and there is a cut that can be considered a laceration injury. 

This kind of injury can be termed a laceration wound. It can be of different forms; it can be shallow as a cut or even very deep that the wound can damage the subcutaneous tissue itself. The laceration wound can also be long or short depending on the type of object that has caused the laceration injury. It can also be wide or narrow. 


Laceration Injury

The laceration as we now know is basically tearing of the skin due to a deep cut either by accidents with knives or any sharp objects, tools can be kitchen tools or stationery items and even carpentry tools and machinery are frequent causes of lacerations.

A laceration wound can be of any form. Different types of scenarios may either lead to an infection or even cause serious damage. 

  1.  In case there are no organisms or dirt or even sand present at the site of the wound then it is a clean wound and can be healed properly and quickly.

  2. In case of where the laceration injury is caused due to a car accident or any sort of road accidents or even in the playground one is in contact with a lot of sand and dirt. Such laceration wounds are exposed to many other microbes which find it to be their breeding grounds, this type is the contaminated laceration wound.

  3. If the injury is exposed to pathogenic and disease-causing microorganisms, in no time, the wound will be infected and the severity will only increase over time.


Laceration Wound Causes 

A laceration is a type of open wound and its causes are basically the result of the skin hitting an object or an object hitting the skin with a force it can be through-

(a) Abrasion when skin rubs or scrapes against a rough or hard surface like in the case of a road rash.

(b) A puncture that leads to tearing of skin through a small hole caused by a pointy, long object like a needle or nail. Even a gunshot wound can be termed a puncture laceration wound caused by the bullet. 

(c) A penetration wound where a sharp object cuts the wound both at the site of entry and the exit of a bullet when it penetrates through the skin can cause this kind of laceration wound. Both puncture and penetrating laceration wounds may not show signs of bleeding but they are highly likely to cause damage to the internal organs and internal bleeding is more damaging to the body since it will take longer to heal. 

(d) The other cause of laceration wound is when there is a partial or even complete tearing of the skin and the tissue beneath due to body-crushing and violent accidents or when one is a victim of an explosion. This kind of laceration wound is called an avulsion where skin and the tissue beneath is affected and damaged. 


Types of Laceration

Lacerations are the tears or splits of skin, mucous membrane, muscle or internal organs. Often produced by the application of blunt force to a broad area of the body, lacerations crush or stretch the tissues beyond their elasticity. Let us get a look into the different types of laceration;

  1. Contused Laceration- The cut or injury in this type of laceration is not on the top layer of the skin rather it is in the tissues under the skin, leaving the skin unbroken and traumatising the soft tissue. Blunt impact to any bony area of the body is likely to produce contusion when overlying tissues are forcibly and rapidly compressed against the bone. When the margins are abraded it is also referred to as abraded laceration.

  2. Split Laceration- This is also called slit laceration because the skin splits due to a slit when it is crushed between two hard objects. The hard objects can be bone, or the object itself or even the ground. 

  3. Incised Laceration- This kind of laceration displays very clean, sharp wound edges without any tissue bridging or excessive skin crushing. People upon a cursory glance, often misinterpret a slit/split laceration to be an incised laceration wound so a close examination is required. The site of injury can be the scalp, eyebrows, forehead etc. 

  4. Stretch Laceration- This type of laceration is caused by overstretching of skin which may cause the skin layer to protrude like a flap when the skin is fixed. When one runs over a running vehicle this kind of laceration can be seen.

  5. Tear Laceration- When the skin comes in contact and rubs against irregular or semi-sharp objects, such as the door handle of the car the tearing of skin and tissues can occur from such impact. The tear in this laceration injury is deeper in the beginning than at the termination point.

  6. Cut Lacerations- This is caused due to a heavy and sharp-edged instrument, it crushes and stretches a broad area of the skin and then splits open in the centre. The tissues bleed due to trauma caused by cut and tear. 

Along with laceration on the skin and the tissues, internal damage is also possible and there is more chance of that when the visceral organs are affected. It leads to fatal bleeding, temporal arteries may bleed freely because they cannot contract due to the damage, blood may cause irritation, pain and dysfunction if it oozes into voids. It may also result in a pulmonary or systemic fat embolism.


Treatment of Lacerated Wound 

The laceration of all types lead to a certain kind of damage even though the degree might vary the repair is absolutely necessary due to the following reasons;

  • Dirt and debris might still remain even after cleaning. 

  • When the depth of the laceration is more than1/4th or 1/8th inside the skin.

  • When other than skin there is exposed muscle, fat, tendon or bone.

  • When bleeding continues even after twenty minutes after the injury is caused it is crucial to repair the wound.

  • Some areas in the body require immediate tending more than others like near the eyes, or any area wherein general more stress is induced.

  • When the injury is deeper there is a high chance of it leaving a scar hence the repair to prevent scarring.


Steps of Treatment

  1. Prevent Bleeding- this step is also called hemostasis. Since bleeding is very common in a laceration injury it is only sensible to first stop the bleeding by applying direct pressure on the wounded area and prevent blood loss. 

  2. Cleaning and Protecting the Wounded Area of Skin- This step can be done immediately after the bleeding has stopped. Clean with warm water or even tap water will do, use sterile saline solution or antiseptic solution. If any chance of contamination is positive, it is very important to use antibiotics solutions else this is not a requirement.

  3. Closure of the Wound- If the cut is very deep or over a joint, it is crucial that the wound be closed after proper cleaning. A tetanus shot is required to prevent infection and further spread. Immediate treatment is very necessary, within the first 12 hours of the injury if deep it should be closed or sutured. And if the wound has been open for a day or period of 24 hours there are high chances that it is contaminated. Because such contaminated deep wounds cannot be self-cleaned it is necessary to see a doctor. 

The possible method of choice for closing such wounds would be bandages, cyanoacrylate glue, staples, and stitches or sutures. Absorbable sutures are more beneficial because in this case there are fewer chances of scarring and infection and not requiring removal over non-absorbable sutures that requires continuous care and attention as it easily loses their effectiveness.  

  1. Follow-up - After proper treatment and closing of the wound it is necessary to follow up with a professional if it does not heal in case of a deep and severe injury. In minor injuries after cleaning and closing it completely heals. 

Stages of Healing 

The process of healing for the deep injury is slow even when treated well. Let us take a look into the stages from when the wound is fresh till it completely healed.

  • Fresh wound-  When the wound is fresh there is bleeding and after it is prevented the fresh clot appears swollen and the margins are red even the wounded part of the skin is red as well.

  • After 12-24 hrs- The margins are still swollen and red however the clot is covered with lymph and is no longer tender it becomes drier. 

  • After 3-5 days- The margins strongly adhere with each other and are covered by dried crust appearing to be relatively drier.

  • After 6-7 days- The dried crust or scab falls off on its own as a new layer of healed skin is formed. If it does not naturally fall off it can easily be taken off leaving a soft reddish tender scar.

  • After a few weeks- The scar is whitish still trying to blend in with the natural skin and the wounded portion is relatively more firm but it is now painless.


Laceration Possible Side Effects

The wound when left on its own and left untreated and even if not immediately treated leads to certain side effects that might remain for a shorter duration or even stay for a longer period of time in the skin.

  • Possibility of infection depending on the pathogenic microorganisms.

  • This also leads to more bleeding and hence more blood loss that can make a person weaker and even lower the immunity and may prolong the healing process.

  • Noticeable scarring if left unattended for many hours of the day. 

  • If one tries to do it by themselves instead of going to an expert it may lead to more damage because of poor wound closure.

  • The other side effect even after getting treatment is a possible allergic reaction to the anaesthetic.


Conclusion 

A laceration is a very common type of injury and in most cases is due to skin cuts and tear of tissues which sometimes go deeper than the skin itself and may penetrate the skin and even damage the tissues. It will lead to further damage if not treated on time so do get professional help. If a minor laceration injury is caused then immediately disinfectant it, and see to it that heals completely. Since it is very common one must be aware of all sorts of the available process of treatment possible. The basic understanding of self-aid must also be also made aware.

FAQ (Frequently Asked Questions)

1. Are Stitches Mandatory For Lacerations to Heal?

Ans. Stitches or sutures are only needed when the cut is deep. Because when the cut is deep the tissues in the lower layer are affected so stitches are made for it to effectively heal. Stitches are inefficient in case of minor laceration injuries. 

2. Are Cut and Laceration the Same Type of Wound?

Ans. A cut is also an injury that tears the skin but laceration and cut are not the same types of wound. The laceration is a deeper wound than a cut. And while laceration can be considered a type of cut but cut is not a kind of laceration. 

3. How to Know Laceration Has Led to an Infection?

Ans. Laceration injury when untreated leads to infection and one can find so when they observe expanding redness around the wound, yellow or greenish-coloured pus or cloudy wound drainage.


Additionally, red streaking spreading from the wound and increased swelling, tenderness, or pain around the wound is seen,  one even suffers from fever and feels weak. 

4. Is Home Treatment For Laceration Possible?

Ans. At-home treatment should only be up to limiting the bleeding caused due to injury and cleaning the wound to avoid infection. This should be done when one cannot reach the hospital immediately. However one should also be careful not to treat deep wounds since it is not convenient to do so on your own.