• Use universal precautions.
• Document laceration length and depth.
• Assess neurovascular status and investigate for tendon, muscle,
or vascular injury.
• Lidocaine is the most commonly used anesthetic for simple wound
• Epinephrine may be added to reduce local bleeding but
is contraindicated in end organs (eg, penis, toes, fingers, nose,
• Sodium bicarbonate can be combined with lidocaine to reduce pain
associated with infusion.
• When administering the anesthetic, proceed in a slow, steady
manner because rapid delivery can result in a burning sensation.
• The maximum dose of plain lidocaine is 5 mg/kg. When
combined with epinephrine, it is 7 mg/kg.
• Bupivacaine, an alternative to lidocaine, has a much longer duration
• Topical anesthetics such as LET (lidocaine, epinephrine, and
tetracaine), which can be infused directly into a wound, are a needleless
alternative to lidocaine.
• Effectiveness requires 10–20 minutes for the
medications to absorb.
• For some procedures, they do not provide sufficient anesthesia
alone and are used in combination with injected lidocaine.
• Clean the skin with detergent or povidone-iodine solution.
• Inspect visually for tendon, neurovascular, or deep tissue injury,
or the presence of a foreign body.
• A finger may be placed inside the wound to explore the depth
• Copious irrigation under pressure reduces infection risk.
• Removal of contaminated, nonviable, or devitalized tissue is
done using either a scissors or scalpel.
• Trimming into a lenticular shape allows for simplest wound edge
approximation and repair.
• Align appropriate tissue layers to prevent unnecessary scarring.