Chapter 51

Postoperative care begins after laceration repair in the ED and continues after discharge with instructions provided to the patient, so that the outcome of wound repair is optimized and complications are minimized. Immediately after repair, the injured area should be gently cleansed with normal saline or clean (tap) water to remove any residual blood products or contamination. Postoperative considerations that should be individually considered for each patient include the use of dressings, topical antibiotics, systemic antibiotics, need for splinting, and evaluation of tetanus status. Before ED release, the patient should be counseled regarding wound cleansing, pain control, signs of infection, and short-term and long-term cosmetic expectations.

Postoperative wound dressing should be tailored to both the type of wound and method of wound closure. Many sutured or stapled lacerations should be covered with a protective, nonadherent dressing for 24 to 48 hours. Maintaining a moist environment increases the rate of re-epithelialization, and occluded wounds heal faster than those exposed to air.1 Although leaving lacerations exposed to air may result in a slightly lower healing rate, it does not result in an increased rate of infection.2 Therefore, although dressings are one strategy that can be used to maintain a moist wound environment, alone they have not been shown to decrease the infection rate.

Semipermeable films are manufactured from transparent polyurethane or similar synthetic films coated on one surface with a water-resistant hypoallergenic adhesive. They are highly elastic, conform easily to body parts, and are generally resistant to shear and tear. They are permeable to moisture vapor and oxygen but impermeable to water and bacteria. Common brands of semipermeable wound dressings are OpSite Post-Op® (Smith & Nephew PLC, London, UK), Bioclusive® (Johnson & Johnson, New Brunswick, NJ), and Tegaderm® (3M, St. Paul, MN). The disadvantages of these products are that they cannot absorb large amounts of fluid and exudate, and they do not adhere well in very moist states.

An alternative to the use of commercial dressings to maintain a moist environment is the use of topical antibiotic creams or ointments. Topical antibiotics can be used to maintain a moist environment in sutured or stapled lacerations, and as an added benefit, may help reduce infection rates and may also prevent scab formation.3 However, patients whose lacerations are closed with tissue adhesives should not use topical ointments or creams because they will loosen the adhesive and may result in dehiscence. Tissue adhesives serve as their own antimicrobial barrier and occlusive dressing; wounds closed with tissue adhesives do not require supplementary dressings.

For wounds with associated soft tissue contusion, the injury site should be elevated above the patient’s heart to limit the accumulation of fluid in the wound interstitial spaces. Wounds with little edema heal more rapidly than those with marked edema. Although few wounds actually require splinting, splints are quite useful for extremity injuries, especially over joints, as they will decrease movement of ...

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