What Can Be Used To Repair Polypropylene Plastic
Laceration Repair: A Practical Approach
Am Fam Physician. 2017 May xv;95(10):628-636.
Patient data: Run into related handout on taking care of healing cuts.
This clinical content conforms to AAFP criteria for continuing medical education (CME). See the CME Quiz Questions.
Author disclosure: No relevant financial affiliation.
Article Sections
- Abstract
- Approach to the Wound
- Wound Repair
- Laceration Aftercare
- References
The goals of laceration repair are to achieve hemostasis and optimal cosmetic results without increasing the risk of infection. Many aspects of laceration repair have not changed over the years, but there is show to support some updates to standard direction. Studies have been unable to define a "gilded catamenia" for which a wound can safely be repaired without increasing risk of infection. Depending on the blazon of wound, it may be reasonable to close even 18 or more hours afterwards injury. The use of nonsterile gloves during laceration repair does not increase the risk of wound infection compared with sterile gloves. Irrigation with drinkable tap water rather than sterile saline as well does non increase the take chances of wound infection. Skilful testify suggests that local anesthetic with epinephrine in a concentration of upward to 1:100,000 is safe for use on digits. Local coldhearted with epinephrine in a concentration of 1:200,000 is safe for use on the nose and ears. Tissue adhesives and wound adhesive strips can exist used effectively in low-tension peel areas. Wounds heal faster in a moist surroundings and therefore occlusive and semiocclusive dressings should be considered when available. Tetanus prophylaxis should be provided if indicated. Timing of suture removal depends on location and is based on expert opinion and feel.
Approximately 6 meg patients present to emergency departments for laceration treatment every year.1 Although many patients seek intendance at emergency departments or urgent care centers, primary intendance physicians are an important resource for urgent laceration treatment. Many aspects of laceration repair take not changed, but in that location is evidence to support some updates to standard direction.
SORT: KEY RECOMMENDATIONS FOR PRACTICE
| Clinical recommendation | Evidence rating | References |
|---|---|---|
| Noninfected wounds caused by clean objects may undergo master closure up to xviii hours after injury. Head wounds may exist repaired upward to 24 hours after injury. | B | 2, seven–9 |
| Using beverage tap water instead of sterile saline for wound irrigation does non increase the risk of infection. | A | 2, ten–12 |
| Use of clean nonsterile examination gloves rather than sterile gloves during wound repair does non significantly increase risk of infection. | A | xi, 18–20 |
| If in that location is no concern for vascular compromise to an appendage, local anesthetic containing epinephrine in a concentration of up to ane:100,000 is safe for apply in laceration repair of the digits, including for digital occludent. | B | 29, 30 |
Arroyo to the Wound
- Abstruse
- Arroyo to the Wound
- Wound Repair
- Laceration Aftercare
- References
The goals of laceration repair are to reach hemostasis and optimal cosmetic results without increasing the risk of infection. Important considerations include timing of the repair, wound irrigation techniques, providing a clean field for repair to minimize contamination, and appropriate utilise of anesthesia. An article on wound care was previously published in American Family unit Physician.2
EVALUATING THE WOUND
When a patient presents with a laceration, the physician should obtain a history, including tetanus vaccination status, allergies, and time and mechanism of injury, and and then assess wound size, shape, and location.3 If agile bleeding persists after awarding of direct pressure level, hemostasis should be obtained using hemostat, ligation, or sutures earlier further evaluation. Hemostasis controls bleeding, prevents hematoma formation, and allows for deeper inspection of the wound.3 The next stride is to determine whether vessels, tendons, fretfulness, joints, muscles, or bones are damaged. Anesthesia may be necessary to reach hemostasis and to explore the wound. Devitalized and necrotic tissue in a traumatic wound should be identified and removed to reduce risk of infection.4,five
If a foreign body (due east.g., clay particles, wood, glass) is suspected but cannot exist identified visually, then radiography, ultrasonography, or computed tomography may exist needed. About one-third of foreign bodies may be missed on initial inspection.6
Injuries that require subspecialist consultation include open up fractures, tendon or muscle lacerations of the paw, nerve injuries that impair office, lacerations of the salivary duct or canaliculus, lacerations of the eyes or eyelids that are deeper than the subcutaneous layer, injuries requiring sedation for repair, or other injuries requiring handling across the knowledge or skill of the physician.
TIMING OF WOUND CLOSURE
No randomized controlled trials (RCTs) accept compared primary and delayed closure of nonbite traumatic wounds.7 One systematic review and a prospective cohort study of 2,343 patients found that lacerations repaired afterwards 12 hours have no significant increment in infection risk compared with those repaired earlier.one A instance serial of 204 patients found no increased risk of infection in wounds repaired at less than 19 hours.viii Noninfected wounds acquired by clean objects may undergo chief closure up to 18 hours afterward injury. Caput wounds may be repaired up to 24 hours after injury.8 Factors that may increase the likelihood of infection include wound contamination, laceration length greater than v cm, laceration located on the lower extremities, and diabetes mellitus.9
WOUND IRRIGATION
Irrigation cleanses the wound of debris and dilutes bacterial load before closure. However, there is no strong evidence that cleansing a wound increases healing or reduces infection.10 A Cochrane review and several RCTs support the use of potable tap water, as opposed to sterile saline, for wound irrigation.two,10–13 To dilute the wound's bacterial load below the recommended 105 organisms per mL,14 l to 100 mL of irrigation solution per i cm of wound length is needed.15 Optimal pressure level for irrigation is around 5 to eight psi.16 This can be accomplished by using a 19-gauge needle with a 35-mL syringe or by placing the wound nether a running faucet.16,17 Physicians should article of clothing protective gear, such as a mask with shield, during irrigation.
Clean VS. STERILE GLOVES
Utilise of make clean nonsterile examination gloves, rather than sterile gloves, during wound repair has little to no bear upon on rate of subsequent wound infection. An RCT of 493 patients undergoing skin excision with primary closure revealed that clean gloves were non junior to sterile gloves regarding infection risk.18 A larger RCT with 816 patients and good follow-up revealed no statistically pregnant difference in the incidence of infection between make clean and sterile glove use.19 Smaller observational studies support these findings.11,20
Lacerations are considered contaminated at presentation, and physicians should make every effort to avert introducing additional bacteria to the wound. However, strict sterile techniques appear to be unnecessary. Sutures, needles, and other instruments that touch the wound should be sterile, but everything else only needs to be make clean.
ANESTHETIZING THE WOUND
Topical and injectable local anesthetics reduce hurting during treatment of lacerations and may be used alone or in combination.21–23 Topical anesthetics (eTable A) are particularly useful when treating children. Topical agents commonly used in the Us include lidocaine/epinephrine/tetracaine and lidocaine/prilocaine. Lidocaine/prilocaine is not approved by the U.S. Food and Drug Administration for utilize on nonintact skin, although it has been used this mode in numerous studies.
eTable A.
Topical Anesthetics for Laceration Repair
| Agent | Forms | Recommended age | Dosage | Application | Onset of action | Elapsing of activeness |
|---|---|---|---|---|---|---|
|
|
| |
|
|
|
|
|
|
|
|
|
|
When using an injectable local coldhearted, the pain associated with injection can be reduced by using a high-approximate needle, buffering the anesthetic, warming the anesthetic to body temperature, and injecting the coldhearted slowly.24–28 Lidocaine may be buffered by adding one mL of sodium bicarbonate to nine mL of lidocaine i% (with or without epinephrine).27
If there is no concern for vascular compromise to an bagginess, then local anesthetic containing epinephrine in a concentration of up to 1:100,000 is safe for use in laceration repair of the digits, including for digital blockade.29,thirty Local coldhearted containing epinephrine in a concentration of 1:200,000 is prophylactic for laceration repair of the nose and ears.31 A systematic review documents the safe use of lidocaine with epinephrine (in a concentration upward to 1:eighty,000) in more than 10,000 procedures involving digits without any reported incidence of necrosis.30 Merely two studies examined the condom of epinephrine-containing anesthetics in patients with peripheral vascular illness. Although no patients had ischemic complications, the studies were small. Concern for peripheral vascular compromise should be considered a contraindication to the use of an epinephrine-containing anesthetic.
Wound Repair
- Abstract
- Arroyo to the Wound
- Wound Repair
- Laceration Aftercare
- References
Laceration closure techniques are summarized in Table 1. For a video of suturing techniques, see https://www.youtube.com/spotter?v=-ZWUgKiBxfk. There are no significant studies to guide technique option. Compared with multilayer repair, single layer repair has similar cosmetic results for facial lacerations32 and is faster and more price-constructive for scalp lacerations.33 Running sutures reportedly have less dehiscence than interrupted sutures in surgical wounds.34 Mattress sutures (Figures i 35 and ii 35) are effective for everting wound edges.36,37 One-half-buried mattress sutures are useful for everting triangular edges in flap repair (Figure 3). Corrective outcomes of facial wounds repaired without deep dermal sutures are like to layered closure.37 The approach to repair varies by wound location. Nonbite and seize with teeth wounds are treated differently because of differences in infection risk. Effigy 4 is an algorithm for the management of lacerations.
Table one.
Laceration Closure Techniques
| Technique | Comments |
|---|---|
| Simple interrupted sutures | General tissue approximation |
| Can be used for near wounds | |
| Simple running sutures | Fast and effective for long lacerations |
| All sutures are lost if one suture is cut by fault or removed for drainage | |
| Horizontal mattress sutures (Effigy 1) | Constructive for everting wound edges |
| Can cause skin necrosis and excessive scars | |
| Vertical mattress sutures (Effigy two) | Most constructive for everting wound edges |
| Can crusade peel necrosis and excessive scars | |
| Half-buried mattress sutures (Figure 3) | Almost constructive in everting triangular wound edges in flap repair |
| Running subcuticular sutures | Fast and effective in accurate skin border apposition |
| Does not allow for drainage | |
| Suited for closing clean wounds, such as surgical wounds in the operating room | |
| Interrupted dermal sutures | Effective in accurate pare edge apposition and wound eversion |
| Allows for minimal drainage | |
| Suited for endmost make clean wounds | |
| Staples | Fast, creates loose closure |
| Allows for drainage | |
| Suited for unclean wounds | |
| Should be avoided if corrective result is important | |
| Wounds adhesive strips | Fast, no anesthesia required |
| Used to approximate clean, elementary, small lacerations with footling tension and without haemorrhage | |
| Tissue adhesive | Fast, no anesthesia required |
| Used to guess make clean, simple, small lacerations with little tension and without bleeding |
Figure 1.
Horizontal mattress sutures.
Reprinted with permission from Forsch RT. Essentials of peel laceration repair. Am Fam Doc. 2008;78(8):948.
Effigy 2.
Vertical mattress sutures.
Reprinted with permission from Forsch RT. Essentials of peel laceration repair. Am Fam Doctor. 2008;78(8):948.
Figure 3.
Half-cached mattress sutures.
Management of Acute Lacerations
Figure 4.
Algorithm for the management of acute lacerations.
FACIAL LACERATIONS
Debridement of facial wounds should be conservative because of increased blood supply to the face. Removing subcutaneous fat may atomic number 82 to depression of the scar.38 Single layer five-0 or 6-0 nylon sutures are sufficient.32
LIP LACERATION THROUGH VERMILION BORDER
An optimal cosmetic event depends on reapproximation of the vermilion border. Therefore, the starting time skin suture should be placed at this edge. The border should exist marked earlier anesthetic injection because the anesthetic may blur the edge. The muscle layer and oral mucosa should be repaired with 3-0 or 4-0 absorbable sutures, and pare should be repaired with 6-0 or vii-0 nylon sutures.
EYELID
The patient should exist referred to ophthalmology if the laceration involves the eye itself, the tarsal plate, or the eyelid margin, or penetrates deeper than the subcutaneous layer. Laceration through the portion of the upper or lower lid medial to the punctum oftentimes damages the lacrimal duct or the medial canthal ligament and requires referral to an ophthalmologist or plastic surgeon. Laceration of upper or lower eyelid pare can be repaired with 6-0 nylon sutures.
Countenance
The edges of the eyebrow serve as landmarks, so the eyebrow should non be shaved. Placing a single suture at each margin first ensures expert alignment.37
EAR
Cartilage has poor circulation and is prone to infection and necrosis. It needs to be covered with skin to heal. A single bite with reverse cutting needle or tapered needle (half dozen-0 polypropylene sutures) should be used to approximate skin and perichondrium simultaneously. Ear trauma ofttimes causes a hematoma, and applying a force per unit area dressing tin be difficult. Fluffed gauze under a circumferential head wrap can reach adequate pressure to prevent a hematoma.
SCALP
A rich blood supply to the scalp causes lacerations to drain significantly. After ruling out intracranial injury, haemorrhage should be controlled with direct pressure for adequate exploration of the wound. Shaving the expanse is rarely necessary. If the galea is lacerated more than 0.v cm information technology should be repaired with 2-0 or 3-0 absorbable sutures.39 Skin tin be repaired using staples; interrupted, mattress, or running sutures, such as three-0 or 4-0 nylon sutures; or the pilus apposition technique (Figure 5 35). Staples are faster and more price-effective than sutures with no difference in complications.twoscore The hair apposition technique using tissue adhesive has the lowest cost and highest patient satisfaction for scalp repair.41 A video of the hair opposition technique is bachelor at https://lacerationrepair.com/alternative-wound-closure/hair-apposition-technique/.
Effigy five.
Hair apposition technique for laceration closure. Opposing strands of hair are brought together with a simple twist and are secured with a drop of tissue adhesive.
Reprinted with permission from Forsch RT. Essentials of pare laceration repair. Am Fam Physician. 2008;78(8):949.
HANDS AND FOREARM
Lacerations of the fingers, hands, and forearms can be repaired by a family physician if deep tissue injury is not suspected. These lacerations are repaired with 4-0 or 5-0 nylon sutures. Any suspicion of injury involving tendon, nervus, muscle, vessels, bone, or the nail bed warrants firsthand referral to a manus surgeon. Traditionally, a large subungual hematoma involving more than than 25% of the visible boom indicated blast removal for smash bed inspection and repair, but a recent review concluded that a subungual hematoma without significant fingertip injury tin be treated with trephining (drainage through a pigsty) lone.42
Seize with teeth WOUNDS
Up to 19% of bite wounds become infected. Cat bites are much more likely to become infected compared with dog or human bites (47% to 58% of cat bites, eight% to 14% of dog bites, and 7% to ix% of human bites).43 The risk of infection increases equally fourth dimension from injury to repair increases, regardless of suture textile.iv Show on optimal timing of primary closure and antibiotic treatment is defective.four,44
Cosmesis was improved with suturing compared with no suturing in RCTs of patients with dog bites, although the infection rate was the aforementioned.44,45 Therefore, dog seize with teeth wounds should be repaired, especially facial wounds considering they are less prone to infection.4,46 Cat bites, with higher infection rates, take better outcomes without main closure, particularly when not located on the face or scalp. Bite wounds with a loftier risk of infection, such as cat bites, deep puncture wounds, or wounds longer than 3 cm,43 should be treated with safe amoxicillin/clavulanate (Augmentin).47,48 Clindamycin may be used in patients with a penicillin allergy.49
CHOOSING THE APPROPRIATE SUTURE Material
Physicians should use the smallest suture that will requite sufficient strength to reapproximate and support the healing wound.l,51 Unremarkably used sutures are included in Tabular array 250,51; nonetheless, skillful bear witness is lacking regarding the appropriate suture size for laceration repair. The 5-0 or six-0 sutures should be used for the face, and 4-0 sutures should be used for virtually other areas. The 3-0 sutures piece of work well for the thicker skin on the back, scalp, palms, and soles.50,51
Table 2.
Commonly Used Suture Materials
| Material | Common needle type* | Time to lose 50% strength | Configuration | Typical use |
|---|---|---|---|---|
| Absorbable | ||||
| Chromic | Opposite cutting | 10 to xiv days | Monofilament | Mucosa, eye wounds |
| Glycolide/lactide polymer (polyglactin 910 [Vicryl]) | Conventional or contrary cutting | 2 to 3 weeks | Braided | Deep dermal, muscle, fascia, oral mucosa, genitalia wounds |
| Poliglecaprone (Monocryl) | Conventional and reverse cutting | 7 to x days | Monofilament | Dermal, subcuticular wounds |
| Polydioxanone (PDS II) | Opposite cutting | 4 weeks | Monofilament | Muscle, fascia, dermal wounds |
| Nonabsorbable | ||||
| Nylon (Ethilon) | Cutting edge | > 10 years | Monofilament | Skin |
| Polypropylene (Prolene) | Tapered point, edgeless tip | Indefinite | Monofilament | Mostly used in vascular surgeries; tin be used for pare, tendon, and ligaments, depending on the needles |
| Silk | Does not come with needle | one year | Braided | Used for hemostasis in ligation of vessels or for tying over bolsters |
A meta-analysis of 19 studies of skin closure for surgical wounds and traumatic lacerations constitute no significant difference in cosmetic result, wound infection, or wound dehiscence between absorbable and nonabsorbable sutures.52,53 A systematic review did not bear witness any advantage of monofilament sutures over braided sutures with regard to cosmetic outcome, wound infection, or wound dehiscence.54
Utilise OF TISSUE ADHESIVE OR WOUND Agglutinative STRIPS
The two types of tissue adhesive bachelor in the United States are north-butyl-2-cyanoacrylate (Histoacryl Blue, PeriAcryl) and 2-octyl cyanoacrylate (Dermabond, Surgiseal). Table three shows the criteria for tissue adhesive use. A Cochrane review found these adhesives to be comparable in cosmesis, procedure fourth dimension, discomfort, and complications.55 They work well in make clean, linear wounds that are non nether tension. They are not generally used in pilus-bearing areas (except in the hair apposition technique). There is a slightly higher likelihood of wound dehiscence with tissue adhesives than with sutures, with a number needed to damage of 25 for tissue adhesives.52,53
Tabular array 3.
Criteria for Use of Tissue Adhesives
| Wound less than 12 hours onetime |
| Linear (non stellate) |
| Hemostatic |
| Not crossing a articulation |
| Not crossing a mucocutaneous junction |
| Not in a pilus-bearing area (unless hair apposition technique is being used) |
| Not under significant tension (or tension relieved with deep absorbable sutures) |
| Not grossly contaminated |
| Non infected |
| Not devitalized |
| Not a outcome of mammalian bite |
| No chronic condition that might impair wound healing |
Tissue adhesive should not be applied to misaligned wound edges. Care should exist taken to avoid getting tissue adhesive into the wound or accidentally adhering gauze or instruments to the wound. If tissue agglutinative is misapplied, it should exist wiped off speedily with dry gauze. To remove dry adhesive, petroleum-based ointment should be practical and wiped away after 30 minutes.
Wound agglutinative strips can also be used. One analysis suggests that wound adhesive strips are the about cost-effective method of closure for appropriate low-tension wounds.56 The strips are practical perpendicular to the vector of the wound to approximate and secure the edges. One study plant the same cosmetic outcomes with adhesive strips vs. tissue adhesive when used to repair facial lacerations.57
Laceration Aftercare
- Abstract
- Arroyo to the Wound
- Wound Repair
- Laceration Aftercare
- References
Once a wound has been fairly repaired, consideration should be given to the elements of aftercare. Although patients accept traditionally been instructed to keep wounds covered and dry for 24 hours, one study institute that uncovering wounds for routine bathing within the first 12 hours afterward closure did not increase the risk of infection.58
A small prospective study showed that traumatic lacerations repaired with sutures had lower rates of infection when antibiotic ointment was practical rather than petroleum jelly. The lowest charge per unit of infection occurred with the use of an ointment containing bacitracin and neomycin.59 Therefore, topical antibiotic ointment should be applied to traumatic lacerations repaired with sutures unless the patient has a specific antibiotic allergy. A meta-analysis did not show benefit with the use of prophylactic systemic antibiotics for reducing wound infections in unproblematic, nonbite wounds.60
Wounds heal most quickly in a moist environment.61 Occlusive and semiocclusive dressings pb to faster wound healing, decreased wound contagion, decreased infection rates, and increased comfort compared with dry gauze dressings.62 Choice of moisture retentive dressing should exist based on the amount of exudate expected. Transparent motion-picture show (e.g., Tegaderm) and hydrocolloid dressings are readily available and suited for repaired wounds without drainage. Film dressings allow for visualization of the wound to monitor for signs of infection. Gauze dressings with petroleum gel with or without an antibody are usually used for wounds with some drainage. Foam dressings are more absorptive but mostly used for chronically draining wounds. When using interactive dressings such every bit film dressings, hydrocolloid dressings, or foam dressings, they should be changed according to package recommendations, which is anywhere from three to seven days or when fluid aggregating separates the dressing from the surrounding pare.62
Patients with contaminated or high-risk (east.one thousand., deep puncture) wounds who have not had a tetanus booster for more than five years should receive a tetanus vaccine. Patients who have not had at to the lowest degree three doses of a tetanus vaccine or who have an unknown tetanus vaccine history should also receive a tetanus immune globulin. Patients with a clean and minor wound should receive the tetanus vaccine simply if they accept non had a tetanus vaccine for more than 10 years. Tetanus immune globulin is not indicated for make clean, minor wounds (Table 4).63
Sutures should be removed later an appropriate interval depending on location (Tabular array 535). This is based on adept opinion and experience.
Table 4.
Tetanus Wound Direction
| Clean, small-scale wounds | Contaminated or high-risk wounds* | |||
|---|---|---|---|---|
| Tetanus vaccination history | Tdap or Td† | Tetanus immune globulin | Tdap or Td† | Tetanus allowed globulin |
| Unknown or fewer than 3 doses | Yes | No | Yes | Aye |
| 3 or more doses | No‡ | No | No§ | No |
Table 5.
Timing of Suture or Staple Removal
| Wound location | Timing of removal (days) |
|---|---|
| Face up | three to v |
| Scalp | 7 to ten |
| Arms | 7 to 10 |
| Trunk | 10 to 14 |
| Legs | 10 to 14 |
| Hands or feet | 10 to 14 |
| Palms or soles | 14 to 21 |
This article updates previous articles on this topic by Forsch35 and by Zuber.64
Data Sources: The authors used an Essential Prove summary based on the cardinal words facial laceration, laceration, and tissue adhesives. The search included relevant POEMs, Cochrane reviews, diagnostic examination data, and a custom PubMed search. Key words were pare laceration, pare repair, local anesthesia, sterile technique, sterile gloves, and wound irrigation. Search dates: Apr 2022 and January five, 2022.
To see the total article, log in or purchase access.
REFERENCES
show all references
one. Zehtabchi Due south, Tan A, Yadav K, Badawy A, Lucchesi One thousand. The impact of wound age on the infection charge per unit of simple lacerations repaired in the emergency section. Injury. 2022;43(xi):1793–1798. ...
two. Worster B, Zawora MQ, Hsieh C. Mutual questions about wound care. Am Fam Medico. 2022;91(2):86–92.
3. American College of Emergency Physicians. Clinical policy for the initial approach to patients presenting with penetrating extremity trauma. Ann Emerg Med. 1994;23(v):1147–1156.
4. Edlich RF, Thacker JG, Buchanan L, Rodeheaver GT. Modernistic concepts of handling of traumatic wounds. Adv Surg. 1979;13169–197.
5. Haury B, Rodeheaver G, Vensko J, Edgerton MT, Edlich RF. Debridement: an essential component of traumatic wound intendance. Am J Surg. 1978;135(2):238–242.
6. Anderson MA, Newmeyer WL III, Kilgore ES Jr. Diagnosis and treatment of retained strange bodies in the paw. Am J Surg. 1982;144(1):63–67.
vii. Eliya-Masamba MC, Banda GW. Chief closure versus delayed closure for non bite traumatic wounds inside 24 hours mail service injury. Cochrane Database Syst Rev. 2022;(10):CD008574.
8. Berk WA, Osbourne DD, Taylor DD. Evaluation of the 'gilded menstruum' for wound repair: 204 cases from a third globe emergency section. Ann Emerg Med. 1988;17(5):496–500.
9. Quinn JV, Polevoi SK, Kohn MA. Traumatic lacerations: what are the risks for infection and has the 'golden menstruum' of laceration care disappeared? Emerg Med J. 2022;31(2):96–100.
10. Fernandez R, Griffiths R. H2o for wound cleansing. Cochrane Database Syst Rev. 2022;(2):CD003861.
11. Xia Y, Cho Due south, Greenway HT, Zelac DE, Kelley B. Infection rates of wound repairs during Mohs micrographic surgery using sterile versus nonsterile gloves: a prospective randomized airplane pilot study. Dermatol Surg. 2022;37(5):651–656.
12. Moscati RM, Mayrose J, Reardon RF, Janicke DM, Jehle DV. A multi-center comparison of tap h2o versus sterile saline for wound irrigation. Acad Emerg Med. 2007;xiv(5):404–409.
13. Weiss EA, Oldham K, Lin M, Foster T, Quinn JV. Water is a rubber and effective alternative to sterile normal saline for wound irrigation prior to suturing: a prospective, double-blind, randomised, controlled clinical trial. BMJ Open. 2022;3(ane).
14. Marshall KA, Edgerton MT, Rodeheaver GT, Magee CM, Edlich RF. Quantitative microbiology: its application to hand injuries. Am J Surg. 1976;131(6):730–733.
fifteen. Wheeler CB, Rodeheaver GT, Thacker JG, Edgerton MT, Edilich RF. Side-furnishings of loftier pressure irrigation. Surg Gynecol Obstet. 1976;143(5):775–778.
sixteen. Moscati RM, Reardon RF, Lerner EB, Mayrose J. Wound irrigation with tap water. Acad Emerg Med. 1998;five(11):1076–1080.
17. Vocalizer AJ, Hollander JE, Subramanian Due south, Malhotra AK, Villez PA. Force per unit area dynamics of various irrigation techniques commonly used in the emergency section. Ann Emerg Med. 1994;24(ane):36–40.
eighteen. Heal C, Sriharan South, Buttner PG, Kimber D. Comparison non-sterile to sterile gloves for minor surgery: a prospective randomised controlled non-inferiority trial. Med J Aust. 2022;202(i):27–31.
19. Perelman VS, Francis GJ, Rutledge T, Foote J, Martino F, Dranitsaris G. Sterile versus nonsterile gloves for repair of unproblematic lacerations in the emergency department: a randomized controlled trial. Ann Emerg Med. 2004;43(3):362–370.
xx. Creamer J, Davis 1000, Rice W. Sterile gloves: practice they make a divergence? Am J Surg. 2022;204(6):976–979.
21. Adler AJ, Dubinisky I, Eisen J. Does the employ of topical lidocaine, epinephrine, and tetracaine solution provide sufficient anesthesia for laceration repair? Acad Emerg Med. 1998;v(ii):108–112.
22. Ernst AA, Marvez-Valls Eastward, Nick TG, Weiss SJ. LAT (lidocaine-adrenaline-tetracaine) versus TAC (tetracaine-adrenaline-cocaine) for topical anesthesia in face and scalp lacerations. Am J Emerg Med. 1995;13(2):151–154.
23. Eidelman A, Weiss JM, Enu IK, Lau J, Carr DB. Comparative efficacy and costs of diverse topical anesthetics for repair of dermal lacerations: a systematic review of randomized, controlled trials. J Clin Anesth. 2005;17(2):106–116.
24. Young KD. What's new in topical anesthesia. Clin Pediatr Emerg Med. 2007;8(4):232–239.
25. Scarfone RJ, Jasani M, Gracely EJ. Pain of local anesthetics: rate of assistants and buffering. Ann Emerg Med. 1998;31(1):36–40.
26. Bartfield JM, Gennis P, Barbera J, Breuer B, Gallagher EJ. Buffered versus apparently lidocaine as a local anesthetic for simple laceration repair. Ann Emerg Med. 1990;19(12):1387–1389.
27. Fatovich DM, Jacobs IG. A randomized controlled trial of buffered lidocaine for local coldhearted infiltration in children and adults with simple lacerations. J Emerg Med. 1999;17(two):223–228.
28. Hogan ME, vanderVaart S, Perampaladas Grand, Machado Yard, Einarson TR, Taddio A. Systematic review and meta-assay of the effect of warming local anesthetics on injection pain. Ann Emerg Med. 2022;58(1):86–98e1.
29. Chowdhry South, Seidenstricker Fifty, Cooney DS, Hazani R, Wilhelmi BJ. Do not utilize epinephrine in digital blocks: myth or truth? Part II. A retrospective review of 1111 cases. Plast Reconstr Surg. 2010;126(six):2031–2034.
thirty. Shridharani SM, Manson PN, Magarakis M, Broyles JM, Whitaker IS, Rodriguez ED. The safety and efficacy of epinephrine in paw surgery: a systematic review of the literature and international survey. Eur J Plast Surg. 2022;37(4):183–188.
31. Häfner HM, Röcken 1000, Breuninger H. Epinephrine-supplemented local anesthetics for ear and nose surgery: clinical use without complications in more 10,000 surgical procedures. J Dtsch Dermatol Ges. 2005;3(3):195–199.
32. Vocalizer AJ, Gulla J, Hein Thou, Marchini S, Chale Due south, Arora BP. Single-layer versus double-layer closure of facial lacerations: a randomized controlled trial. Plast Reconstr Surg. 2005;116(2):363–368.
33. Adeolu AA, Olabanji JK, Komolafe EO, Ademuyiwa AO, Awe AO, Oladele AO. A prospective study of two methods of endmost surgical scalp wounds. Br J Neurosurg. 2022;26(one):75–77.
34. Iwase G, Higaki J, Tanaka Y, Kondoh H, Yoshikawa K, Kamiike West. Running closure of make clean and contaminated abdominal wounds using a synthetic monofilament absorbable looped suture. Surg Today. 1999;29(9):874–879.
35. Forsch RT. Essentials of skin laceration repair. Am Fam Physician. 2008;78(8):945–951.
36. Jones JS, Gartner M, Drew One thousand, Pack S. The shorthand vertical mattress stitch: evaluation of a new suture technique. Am J Emerg Med. 1993;11(5):483–485.
37. Lammers RL, Smith ZE. Methods of wound closure In: Roberts JR, Custalow CB, Thomsen TW, Hedges JR, eds. Roberts and Hedges' Clinical Procedures in Emergency Medicine. Philadelphia, Pa.: Elsevier/Saunders; 2022.
38. Grabb WC, Klainert HE, eds. Techniques in Surgery: Facial and Hand Injuries. Somerville, NJ: Ethicon Inc.; 1980.
39. Hollander JE, Vocalist AJ, Valentine SM, Shofer FS. Risk factors for infection in patients with traumatic lacerations. Acad Emerg Med. 2001;8(7):716–720.
twoscore. Kanegaye JT, Vance CW, Chan 50, Schonfeld North. Comparing of peel stapling devices and standard sutures for pediatric scalp lacerations: a randomized study of cost and time benefits. J Pediatr. 1997;130(five):808–813.
41. Kavalci C, Cevik Y, Durukan P, Sayhan MB. Comparison of different suture techniques. J Clin Anal Med. 2022;6(ane):15–17.
42. Batrick Due north, Hashemi M, Freij R. Handling of unproblematic subungual haematoma. Emerg Med J. 2003;20(one):65.
43. Jaindl M, Oberleitner Thousand, Endler G, Thallinger C, Kovar FM. Management of bite wounds in children and adults—an analysis of over 5000 cases at a level I trauma center. Wien Klin Wochenschr. 2022;128(9–x):367–375.
44. Medeiros I, Saconato H. Antibiotic prophylaxis for mammalian bites. Cochrane Database Syst Rev. 2001;(2):CD001738.
45. Paschos NK, Makris EA, Gantsos A, Georgoulis AD. Principal closure versus non-closure of domestic dog bite wounds. a randomised controlled trial. Injury. 2022;45(1):237–240.
46. Rui-feng C, Li-song H, Ji-bo Z, Li-qiu W. Emergency treatment on facial laceration of dog bite wounds with immediate main closure: a prospective randomized trial study. BMC Emerg Med. 2022;13(suppl 1):S2.
47. Henton J, Jain A. Cochrane corner: antibiotic prophylaxis for mammalian bites (intervention review). J Paw Surg Eur Vol. 2022;37(eight):804–806.
48. Evgeniou Eastward, Markeson D, Iyer S, Armstrong A. The direction of brute bites in the Britain. Eplasty. 2022;13:e27.
49. Ellis R, Ellis C. Domestic dog and cat bites. Am Fam Physician. 2022;90(4):239–243.
50. Wound Closure Transmission. Somerville, NJ: Ethicon Inc.; 2007.
51. Bullocks JM. Plastic Surgery Emergencies: Principles and Techniques. New York, NY: Thieme, 2008.
52. Mouzas GL, Yeadon A. Does the choice of suture material affect the incidence of wound infection? A comparison of dexon (polyglycolic acid) sutures with other commonly used sutures in an accident and emergency department. Br J Surg. 1975;62(12):952–955.
53. Xu B, Xu B, Wang 50, et al. Absorbable versus nonabsorbable sutures for skin closure: a meta-analysis of randomized controlled trials. Ann Plast Surg. 2022;76(5):598–606.
54. Slieker JC, Daams F, Mulder IM, Jeekel J, Lange JF. Systematic review of the technique of colorectal anastomosis. JAMA Surg. 2022;148(ii):190–201.
55. Farion G, Osmond MH, Hartling L, et al. Tissue adhesives for traumatic lacerations in children and adults. Cochrane Database Syst Rev. . 2002;(3):CD003326.
56. Zempsky WT, Zehrer CL, Lyle CT, Hedbloom EC. Economic comparison of methods of wound closure: wound closure strips vs. sutures and wound adhesives. Int Wound J. 2005;2(three):272–281.
57. Zempsky WT, Parrotti D, Grem C, Nichols J. Randomized controlled comparison of corrective outcomes of simple facial lacerations closed with Steri Strip Skin Closures or Dermabond tissue adhesive. Pediatr Emerg Intendance. 2004;twenty(viii):519–524.
58. Heal C, Buettner P, Raasch B, et al. Can sutures get wet? Prospective randomised controlled trial of wound management in general practice. BMJ. 2006;332(7549):1053–1056.
59. Hood R, Shermock KM, Emerman C. A prospective, randomized airplane pilot evaluation of topical triple antibiotic versus mupirocin for the prevention of elementary soft tissue wound infection. Am J Emerg Med. 2004;22(1):1–3.
60. Cummings P, Del Beccaro MA. Antibiotics to prevent infection of elementary wounds: a meta-assay of randomized studies. Am J Emerg Med. 1995;13(iv):396–400.
61. Winter GD. Formation of the scab and the rate of epithelization of superficial wounds in the pare of the immature domestic pig. Nature. 1962;193293–294.
62. Korting HC, Schöllmann C, White RJ. Direction of minor acute cutaneous wounds: importance of wound healing in a moist environment. J Eur Acad Dermatol Venereol. 2022;25(2):130–137.
63. Tetanus In: Hamborsky J, Kroger A, Wolfe C, eds. Epidemiology and Prevention of Vaccine-Preventable Diseases Atlanta, Ga.: Centers for Illness Control and Prevention; 2022.
64. Zuber TJ. The mattress sutures: vertical, horizontal, and corner stitch. Am Fam Doctor. 2002;66(12):2231–2236.
Copyright © 2022 past the American Academy of Family Physicians.
This content is endemic by the AAFP. A person viewing it online may make one printout of the material and may use that printout only for his or her personal, non-commercial reference. This material may non otherwise exist downloaded, copied, printed, stored, transmitted or reproduced in whatsoever medium, whether now known or later invented, except as authorized in writing past the AAFP. Contact afpserv@aafp.org for copyright questions and/or permission requests.
MOST Contempo ISSUE
Apr 2022
Admission the latest issue of American Family unit Medico
Read the Issue
Email Alerts
Don't miss a single issue. Sign up for the gratis AFP email table of contents.
Sign Up Now
What Can Be Used To Repair Polypropylene Plastic,
Source: https://www.aafp.org/afp/2017/0515/p628.html
Posted by: williamsoftere.blogspot.com
0 Response to "What Can Be Used To Repair Polypropylene Plastic"
Post a Comment