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Incision/Laceration. - Wound Care

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d. Incision/Laceration.
(1)  Description. An incision occurs as a result of a cut by a sharp
instrument. An example of an incision is a cut made with a scalpel during surgery. In
this type of wound, the wound edges are smooth. In a laceration, the tissues are torn
apart and remain jagged and irregular. A wound made by the cut of a saw will be a
laceration. Although the two types of wounds look and are different, treatment for both
is about the same.
(2)  Laceration classification. Lacerations can be further classified into four
categories: shear lacerations, tension lacerations, compression lacerations, and
combination lacerations.
(a) Shear lacerations are caused by sharp objects such as a knife,
blades, etc. Little damage is done to the tissues adjacent to the wound. This type of
laceration heals rapidly. There is minimal scarring due to the health of the tissues at the
edges of the wound.
(b) Tension lacerations are caused when the skin strikes a flat surface
and rips. The rip occurs because the impact causes stress on tissues. In this
laceration, there is no bone directly below the region of the skin that is struck. Tension
lacerations heal with more scarring because of bruising of soft tissue around the
laceration. Using his hands to break the fall, an individual falls on the palm(s) of his
hand(s). He sustains a ragged, linear laceration on the palm of his hand, a tension
laceration.
(c)  In compression lacerations, tissue is caught between the bone and
an external hard surface. Caught in such a manner, the skin bursts. These lacerations
heal with the greatest degree of scarring. The reason is that the skin next to the
laceration is injured. An individual walking along a sidewalk trips and falls. In the fall,
his forehead hits the pavement. He will likely have a compression laceration.
(d) Combination lacerations are as the name suggests, a combination
of different types of lacerations. Imagine this. A person hits a bony prominence against
a table. He sustains a linear laceration as in a shear injury. The wound edges,
however, are crushed as in a compression injury. The combination is shear laceration
and compression laceration.
(3)  Treatment. Be sure you have good lighting and that you use aseptic
technique. Irrigate and mechanically debride the wound. Then, use one of these three
types of closure: primary closure, secondary closure, or tertiary intent closure.
MD0576
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