Goals

The goals of all wound closure methods are to restore function, prevent infection, promote rapid healing, prevent further damage, and restore cosmetic appearance and minimize scarring.

Background

A laceration is classified as an open wound and is a tearing of the skin or other soft tissues. Lacerations may occur as a result of a blunt tearing force, a sharp object, animal or human bites, or puncture wounds. Uncomplicated wounds do not include those that (1) involve nerve, tendon or bone damage, (2) occurred over 12 hours ago, (3) are the result of an animal or human bite, (4) have obvious gross contamination or presence of a foreign body, (5) concerns regarding cosmetic outcome, (6) stab wounds of the neck, chest and abdomen, (7) have full thickness skin loss, or (8) significant tissue deficit is present. A wound with any of the aforementioned characteristics should be considered a complicated laceration and should prompt referral to a health care provider with extensive experience in wound management.

Staples are one method of wound closure in areas of high tension on the trunk, extremities, and scalp. Staples should not be used in delicate tissues (such as the face), over bony prominences, or areas of high mobility. Staples bring the wound edges together to approximate skin layers, eliminate dead space within the wound, and achieve hemostasis. Alternative treatment options to staples include:

• Cleanse and leave it alone (healing by secondary intention)
• Steri-Strips
• Skin adhesive
• Sutures

Contraindications

The following situations warrant referral or for wounds to be left open initially and then closed (delayed primary intention):

• Prolonged interval between injury and attempted closure
• Heavy contamination with feces, human or animal saliva, or a large amount of soil or dirt
• Presence of retained foreign bodies
• Devitalized tissue
• Large superficial denudement of skin or tissue with borderline adequate perfusion
• Cannot be closed without excessive tension
• Nerve damage or bone fracture
• Injury to muscles, tendon, and ligaments
• Stab wounds over major body cavities due to risk of damage to internal organs