Mankowitz Scott L
East Orange General Hospital, East Orange, New Jersey.
J Emerg Med. 2017 Sep;53(3):369-382. doi: 10.1016/j.jemermed.2017.05.026. Epub 2017 Aug 25.
Traumatic lacerations to the skin represent a fairly common reason for seeking emergency department care. Although the incidence of lacerations has decreased over the past decades, traumatic cutaneous lacerations remain a common reason for patients to seek emergency department care.
Innovations in laceration management have the potential to improve patient experience with this common presentation.
Studies have confirmed that delays in wound closure rarely confer increased rates of infection, although comorbidities such as diabetes, chronic renal failure, obesity, human immunodeficiency virus, smoking, and cancer should be considered. Antibiotics should be reserved for high-risk wounds, such as those with comorbidities, gross contamination, involvement of deeper structures, stellate wounds, and selected bite wounds. Topical anesthetics, which are painless to apply, have a role in select populations. In most studies, absorbable sutures perform similarly to nonabsorbable sutures and do not require revisit for removal. Novel atraumatic closure devices and expanded use of tissue adhesives for wounds under tension further erode the primacy of regular sutures in wound closure. Maintaining a moist wound environment with occlusive dressings is more important than previously thought. Most topical wound agents are of limited benefit.
Recent innovations in wound closure are allowing emergency physicians to shift toward painless, atraumatic, and rapid closure of lacerations.
皮肤创伤性撕裂伤是寻求急诊科治疗的相当常见的原因。尽管在过去几十年中撕裂伤的发病率有所下降，但创伤性皮肤撕裂伤仍然是患者寻求急诊科治疗的常见原因。
撕裂伤处理方面的创新有可能改善患者对这种常见病症的就医体验。
研究证实，伤口闭合延迟很少会增加感染率，不过应考虑糖尿病、慢性肾衰竭、肥胖症、人类免疫缺陷病毒、吸烟和癌症等合并症。抗生素应仅用于高危伤口，如伴有合并症、严重污染、累及深层结构、星状伤口和特定咬伤伤口。局部麻醉药应用时无痛，在特定人群中发挥作用。在大多数研究中，可吸收缝线与不可吸收缝线的表现相似，且无需复诊拆线。新型无创闭合装置以及在有张力伤口中扩大使用组织粘合剂，进一步削弱了常规缝线在伤口闭合中的首要地位。使用封闭敷料保持伤口湿润环境比以前认为的更为重要。大多数局部伤口用药益处有限。
伤口闭合方面的最新创新使急诊医生能够转向无痛、无创且快速的撕裂伤闭合方法。
