Postoperative care begins immediately after laceration repair in the ED with gentle cleansing using normal saline or clean (tap) water to remove any residual blood products or contamination. Additional considerations include dressings, topical antibiotics, edema reduction techniques, prophylactic antibiotics, tetanus prophylaxis, and wound drains. Before ED release, give the patient instructions regarding wound care and cleansing, pain control, signs of infection, follow-up dates, 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. Most 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.1-3 Conversely, leaving lacerations exposed to air may result in a slightly lower healing rate but does not result in an increased rate of infection.4
Useful dressings are semipermeable films 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 to very moist wounds.
Topical antibiotic creams and ointments are an alternative to the use of commercial dressings to maintain a moist environment. As an added benefit, topical antibiotics may help reduce infection rates and may also prevent scab formation.5-7 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.
Instruct patients to elevate the injury site for 24 to 48 hours when soft tissue contusion is present to limit accumulation of fluid in the wound area. Wounds with little edema heal more rapidly than those with marked edema. Pressure dressings can be used to minimize the accumulation of intercellular fluid in the subcutaneous space. Pressure dressings are useful for ear and scalp lacerations (see Chapter 42, “Face and Scalp Lacerations”). For large scalp lacerations that have a tendency to bleed, short-term use of a pressure dressing will limit subcutaneous hematoma formation. Avoid excessive pressure in all pressure dressings, especially in the extremities where they may compromise circulation. Tube gauze dressing applied to fingers or toes should not be twisted at the base ...