A laceration appears as a mild to serious breaking of the epidermis of varying size, in which the first layer of the skin is torn from small slices to deep gashes. The breaking might look like a cut, tear, or gash with edges close together or wide apart, and the laceration might hurt, bleed, bruise, or swell. The bleeding varies according to the depth and severity of the damage, going from mild cases, with a brief bleeding and minimal pain, to more severe cases, with profuse bleeding and intense pain. Bleeding might depend on the site of the laceration, as some parts of the body, like the scalp, are more prone to lose blood. Numbness and decreased movement around the area concerned can occur.

• Pain

  DISCUSSION: No difference in the level of pain was found between ketamine and midazolam treated patients. [ncbi.nlm.nih.gov]

  You can take pain medicine, such as acetaminophen, as directed for pain at the wound site. Follow-up with your provider to make sure the wound is healing properly. [mountsinai.org]

• Swelling

  Contusions and lacerations can cause bleeding or swelling in the brain. Contusions and lacerations may be very small, causing only minimal damage to the brain, with few symptoms or symptoms of minor head injury. [msdmanuals.com]

  However, watch for these signs of infection: Fever Foul odor coming from the cut Increased pain Pus or discharge coming from the cut or scrape Redness, swelling or warmth in the affected area If you have any of these symptoms, see your doctor for treatment [thechristhospital.com]

  Cuts on the nose can cause redness, swelling, and bleeding. A broken nose can cause pain, swelling, nasal stuffiness, and bruising around the eyes. Shallow cuts may be closed with strips of surgical tape or skin glue. [mhealth.org]

  Watch the wound for signs of infection, such as increased warmth, swelling, redness, drainage, or pain. Watch the stitches to make sure they are intact and keeping the wound edges together. [urmc.rochester.edu]

• Fever

  Here are guidelines for fever temperature. Ear temperatures aren’t accurate before 6 months of age. Don’t take an oral temperature until your child is at least 4 years old. [mhealth.org]

  We describe a case of a 19-year-old woman with persistent fever and pleural effusion, in which thoracentesis resulted in tension hemothorax due to intercostal artery laceration. [ncbi.nlm.nih.gov]

  However, watch for these signs of infection: Fever Foul odor coming from the cut Increased pain Pus or discharge coming from the cut or scrape Redness, swelling or warmth in the affected area If you have any of these symptoms, see your doctor for treatment [thechristhospital.com]

  When to seek medical advice When to seek medical advice Call your health care provider right away if any of these occur: Shaking chills or fever above 100.4°F (38°C) Bleeding that soaks the dressing Pink fluid weeping from the wound Increased drainage [mountnittany.org]

  Call your healthcare provider right away if any of these occur: Wound bleeding not controlled by direct pressure Signs of infection, including increasing pain in the wound, increasing wound redness or swelling, or pus or bad odor coming from the wound Fever [fairview.org]

• Inflammation

  On examination, anterior segment examination was quiet without any inflammation, anterior vitreous face showed 1+ cells, and dilated funduscopy revealed bilateral symmetrical serous retinal detachments along the posterior pole. [ncbi.nlm.nih.gov]

  […] lacerating or blunt trauma Pain and perhaps blurred vision May be small or hidden behind bloody, swollen conjunctiva Irregular pupil may be clue that iris plugs hole in sclera Blunt trauma to eye, BUT... deformed eye and irregular pupil suggest perforation Inflammation [kellogg.umich.edu]

  If required pain medications or antibiotics may be prescribed to reduce pain and inflammation and prevent infection. Physical therapy is usually prescribed to regain range of motion, strength and function. [woc.com.au]

  Wounds closed with tissue adhesive have less tensile strength in the first 4 days than do sutured wounds, but after 1 week, the tensile strength and overall degree of inflammation in wounds closed with tissue adhesive and with sutures are equivalent. [merckmanuals.com]

• Wound Infection

  The use of nonsterile gloves during laceration repair does not increase the risk of wound infection compared with sterile gloves. Irrigation with potable tap water rather than sterile saline also does not increase the risk of wound infection. [ncbi.nlm.nih.gov]

  Any delay can increase the rate of wound infection. CONTINUE SCROLLING OR CLICK HERE FOR RELATED SLIDESHOW QUESTION Emotional trauma is best described as a psychological response to a deeply distressing or life-threatening experience. See Answer [medicinenet.com]

  Topical Lidocaine applied to the wound (ex, 4% lidocaine soaked gauze for 5 min). Regional blocks are possible, but more challenging in toddlers. Irrigate the Wound Infection is rare… but irrigation will help you evaluate the injury also. [pedemmorsels.com]

  For example, if the wound is more than six hours old, if it is infected, or if it is at high risk of becoming infected, such as a wound contaminated with manure. This delayed closure aims to make sure the wound is not infected before closing it up. [patient.info]

• Tachycardia

  Adverse reactions to local anesthetics include allergic reactions (hives and, occasionally, anaphylaxis) and sympathomimetic effects from epinephrine (eg, palpitations, tachycardia). [merckmanuals.com]

  Back to Top Table 3 Heart injury scale Grade Description of injury ICD-9 AIS-90 I Blunt cardiac injury with minor ECG abnormality (nonspecific ST or T wave changes, premature arterial or ventricular contraction or persistent sinus tachycardia) 861.01 [aast.org]

• Erythema

  At this stage, the scar should flatten, and underlying erythema will resolve. Patients should be advised at this stage to massage the scar as well as avoid direct sunlight to reduce risk hyperpigmentation of the scar. [ncbi.nlm.nih.gov]

  Inflammation Phase: Leukocytes and MacrophagesClinically inflammation, the second stage of wound healing presents as erythema, swelling and warmth often associated with pain, the classic “rubor et tumor cum calore et dolore”. [slideshare.net]

  As collagen remodeling occurs, the scar becomes thinner and loses its erythema. In some patients, however, the scar hypertrophies, becoming unsightly and raised. [merckmanuals.com]

• Skin Tear

  […] noun 1 A deep cut or tear in skin or flesh. [en.oxforddictionaries.com]

  ‘Lacerations generally are ragged tears in the skin with abraded margins.’ ‘Lacerations are common simple problems; their treatment requires tremendous resources.’ [lexico.com]

  They are the closure of choice for "Wet tissue paper" skin tears. Prior to application, degrease the skin with alcohol, being careful not to get any into the wound. [ncemi.org]

  Flap s ( Skin Tear s, especially in elderly) See Skin Tear Facial Nerve region Exercise caution in region of Facial Nerve, especially near Parotid Gland and mandubular branch Risk of permanent nerve injury Prevent excessive swelling that may compress [fpnotebook.com]

• Lacrimation

  After revisional repair, scar contracture and asymmetry of the medial canthus or malposition of the lower lacrimal punctum were corrected. Cosmetically, all 5 patients were satisfied with the results. [ncbi.nlm.nih.gov]

• Contusion

  The authors performed the bifrontal decompressive craniectomy on 56 patients with contusion and laceration of bilateral frontal and temporal lobes, and their follow-up treatment outcomes were tracked within 6 months using Glasgow Outcome Scale. [ncbi.nlm.nih.gov]

  There is almost always concurrent contusion. Contusions and lacerations follow blunt or penetrating chest trauma, and are almost always seen with other chest (and abdominal) injuries. [radiopaedia.org]

  Contusions and lacerations can cause bleeding or swelling in the brain. Contusions and lacerations may be very small, causing only minimal damage to the brain, with few symptoms or symptoms of minor head injury. [msdmanuals.com]

  The blue arrow points to an area of subpleural hemorrhage representing a pulmonary contusion For a photo of the same image without arrows, click here Pulmonary laceration. [learningradiology.com]

• Vaginal Bleeding

  Angiography revealed that the superior rectal branch of the inferior mesenteric artery was one of the origins of persistent vaginal bleeding following embolization of both uterine arteries. [ncbi.nlm.nih.gov]

• Seizure

  A tongue laceration is often the result of a fall, seizure, psychogenic nonepileptic seizure, or other blunt or penetrating force mechanism. [1, 2, 3] Piercings, intoxication, and iatrogenic cause are also commonly associated with tongue injury. [4, 5 [emedicine.medscape.com]

  LD strikes previously normal adolescents, usually beginning with seizures, often associated with some loss of coordination and cognition. [epilepsy.com]

  In this paper we present a case of a 47-year-old male who collapsed suddenly following recent complaints of a headache and a reported seizure. He had a reported history of potential head trauma that occurred several days prior. [ncbi.nlm.nih.gov]

  They may also have vomiting, seizures, or impaired balance or coordination. The ability to think, control emotions, move, feel, speak, see, hear, smell, and remember may be impaired. [msdmanuals.com]

  […] occipital seizures), and progressive neurological decline. [orpha.net]

• Irritability

  Symptoms: ocular irritation, pain and foreign body sensation. Signs include chemosis, subconjunctival hemorrhage and torn conjunctiva. [columbiaeye.org]

  Try to keep soap out of the wound itself because soap can cause irritation. Use tweezers that have been cleaned in isopropyl alcohol (rubbing alcohol) to remove any dirt that remains in the wound after washing. [canyonviewfamilymedicine.com]

  If the laceration involves the oral mucosa, consider recommending a bland diet to avoid irritating the wound. For intraoral wounds, especially if left unclosed, consider discharging the patient with a syringe and saline. [emedicine.medscape.com]

  Nylon sutures have sharp ends and may irritate the oral mucosa. Several methods of closure have been described. [epmonthly.com]

  Silk is best avoided in the mouth, as it can irritate mucosal tissues. Any small intraoral flaps may be excised. See the images below. Closure of an intraoral skin laceration. Placement of intraoral skin suture with buried knot. [medscape.com]

• Headache

  In this paper we present a case of a 47-year-old male who collapsed suddenly following recent complaints of a headache and a reported seizure. He had a reported history of potential head trauma that occurred several days prior. [ncbi.nlm.nih.gov]

  […] nose after swelling goes down Sinus pain Repeated vomiting Changes in vision Leaking of clear fluid from the nose (sign of a more serious problem) Call 911 Call 911 for any of the following: Trouble breathing or shortness of breath Severe or worsening headache [mhealth.org]

  Meanwhile, if you wake up with a splitting headache or serious cold one morning – then call in sick. Even if you can potentially make it into to work, if you’re not able to concentrate then you’ll be a danger to yourself and others. [slideshare.net]

• Paresthesia

  During the first 2 weeks after surgery the patient complained of paresthesia in the mental and lower lip area, with labial ptosis and drooling. [ncbi.nlm.nih.gov]

The diagnosis of a laceration is firstly performed through a complete physical examination, to evaluate the wound and understand its extent and severity. This is usually integrated with cultures of samples taken from the site of the wound and from the blood, to detect the presence of infections. If the laceration is severe, a fracture is suspected and in the presence of a foreign body, like pieces of metal, gravel and glass, is suspected, an X-ray examination should be performed. 

The treatment of a laceration depends on the type, cause, and depth as well as the presence and involvement of other structures over the surface of the damaged skin. In any case, the first step is always cleaning, accomplished using different solutions like tap water and sterile saline solutions [10], whose main goal is to avoid and prevent infections. Follows closure, which should be done immediately with the use of clean and sterile gloves [11] [12] [13]. There are several techniques to carry out closure, which include bandages, cyanoacrylate glue, staples, and sutures, each one of them having their own advantages and disadvantages. Dressing, instead, is the last step of the treatment of laceration, as that of the other types on wound, which consists in the application of a sterile pad, whose goal is to keep the wound clean and avoid further damage. However, the effectiveness of dressing in preventing infection and improve healing itself is at the moment not supported by evidence [14].

The risk of getting tetanus cannot always be ruled out, especially when there are doubts about previous vaccinations or the patient received the last tetanus shot more than 5 years earlier. Tetanus infection is particularly possible when dirt or saliva are present in the laceration or for puncture wounds. In these cases, tetanus vaccination is strongly advised.

Prognosis depends on the severity of the laceration. Minimal superficial lacerations should heal completely within 2 weeks. Healing is a little bit longer with deeper lacerations or for those which occur in areas undergoing regular movements, such as knees and elbows. The situation is more difficult with the lacerations which also involve tendons, that have impaired the use of local muscles, or profuse bleeding from internal organs and blood vessels which might result in severe blood loss and possibly death. In these cases, emergency care is advised.

Bacterial infection is the most common complication of lacerations, which can impede healing and lead to life-threatening conditions. Therefore, it is important to make sure no infection has begun after the damage. Unfortunately, current laboratory-based detection of infections might be very long, taking from several hours to even several days to be completed.

A laceration occurs when an object strike the skin and opens a wound. The severity of the laceration depends on many factors, like the angle of the hit, the force with which the skin has been stricken, the depth of the wound and the nature of the object which has provoked it. Thus, some lacerations might be more serious than others, reaching deeper tissues and provoking more profuse bleeding.

No precise epidemiological data exist on the prevalence and incidence of laceration. However, it is particularly frequent among people who work with sharp instruments and objects, such as machineries equipped with saws or knifes and cutters in the kitchen used by the those working in the food industry. Furthermore, laceration is also the most common nonfatal injury among those aged between 10 to 17 [1].

Healing of the laceration, as well as any type of wound, begins when white blood cells arrive at the site of the damage, to clear the wound and remove debris. Then, an orchestrated cascade of biochemical pathways is set in motion to repair the damaged tissue [2] [3], in a process divided in four main stages:

• Blood clotting (homeostasis) [4] [5]: The wound is essentially plugged thanks to the action of platelets and the gluing mesh of fibrin in which they are bound together. 
• Inflammation: Damaged and dead cells, bacteria and other pathogens are cleared out through phagocytosis.
• Proliferation (new tissue growth): Performed through the important stages of angiogenesis, collagen deposition, granulation tissue formation, epithelialization, and wound contraction, which serve to reconstruct the damaged blood vessels [6] and tissues [7].
• Maturation (tissue remodeling) [8]: Collagen is realigned along the skin tension lines, while unneeded cells are eliminated through apoptosis.

It is important to notice that although wound healing is a complex process, it is also very fragile and very susceptible to interruption and failure, which might result in the formation of non-healing chronic wounds. There are several factors that foster non-healing chronic wound formation and these include diabetes mellitus, cardiovascular diseases, infections, and metabolic deficiencies [9]. Therefore, measures to speed up wound healing are highly recommended.

Since lacerations are provoked by accidental episodes, no particular prevention plan can be recommended, apart from following general safety measures like wearing protective gloves and clothes in environments at high risk of incidents, keep clear from sharp objects and stay away from dangerous equipment and machinery.

A laceration is a tear in tissue due to blunt trauma characterized by incomplete separation of stronger tissue elements. Five types of laceration occur:

• Split laceration occurs when a part of the body is crushed between two external objects. The striking object makes a blunt impact and causes the skin with the tissues underneath to tear from compression. Mostly, this type of laceration occurs on the face, head, hands, and legs. 
• Overstretching is generally caused by a single, angular force which strikes the skin causing it to stretch or break. A typical example of this type of laceration is represented by a gunshot, where the bullet pierces and penetrates the skin with a certain angle, then it lodges underneath the epidermis, compresses and expands causing the skin to tear beyond the initial point of impact.
• Grinding compression occurs when an objects bluntly strikes the skin maintaining a certain angle or with a sweeping motion, provoking a grinding compression. This laceration causes the skin to peel away, while the tissue underneath is crushed.
• Cut laceration consists in a cut provoked by a type of blade that has caused a break of the skin and the tissue underneath. This is the most common type of laceration.
• Tearing occurs when the skin is broken by the hitting object and ripped as a consequence of the pressure pushing the wound in two different directions, as if it was a piece of paper ripped in two smaller ones.

A laceration is a particular type of wound, in which the skin and the soft tissue underneath are cut in an irregular, torn and ragged breaking. Experts distinguish five subtypes of lacerations:

• Split laceration: The lacerations occurs when a part of the body is crushed between two external objects.
• Over-stretching: The laceration is caused by an object with an angular force that causes the skin to stretch and break, like a gunshot. 
• Grinding compression: The laceration is caused by an object with a sweeping motion.
• Cut: The laceration is provoked by an object which causes a deep cut in the skin and the soft tissue underneath.
• Tearing: The laceration is provoked by an object which rips the wound pushing it into two different directions.

In these cases, the wound appears as a breaking of the epidermis in the form of a cut, tear, or gush with edges close together or wide apart and size varying according to the case. The laceration might hurt, bruise, swell, and bleed, while the bleeding degree depends on the site of laceration as well as the severity of the damage.

The diagnosis is usually performed with a complete physical examination, to understand the size and severity of the damage, together with laboratory tests and imaging studies to detect the presence of infections, foreign bodies or hidden bone fractures. The treatment of a laceration, instead, as that of any other type of wound, consists in a first cleaning of the wound, to wash away dirt and debris and avoid infections, followed by closure and finally dressing, to keep the wound clean and prevent as much as possible future complications.

The prognosis of a laceration depends on the severity of the wound itself. If the damage is minimal, the laceration usually heals within a few weeks, otherwise the healing process might take much longer than that, creating the conditions for the occurrence of future possible complications. Since lacerations are provoked by accidental episodes, no particular prevention plan can be recommended, apart from following general safety measures like wearing protective gloves and clothes in environments at high risk of incidents, keep clear from sharp objects and stay away from dangerous equipment and machinery.

1. Rubin A. Managing Abrasions and Lacerations. Physician and Sports Medicine 26 5 (1998): 45-55. 
2. Nguyen DT, Orgill DP, Murphy GF. Chapter 4: The Pathophysiologic Basis for Wound Healing and Cutaneous Regeneration. Biomaterials For Treating Skin Loss. Woodhead Publishing (UK/Europe) & CRC Press (US), Cambridge/Boca Raton, 2009, p. 25-57. 
3. Rieger S, Zhao H, Martin P, Abe K, Lisse TS. The role of nuclear hormone receptors in cutaneous wound repair. Cell biochemistry and function 2014 33 (1): 1–13. 
4. Rasche H. Haemostasis and thrombosis: an overview. European Heart Journal Supplements 2001 3 (Supplement Q): Q3–Q7. 
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6. Chang HY, Sneddon JB, Alizadeh AA, Sood R, West RB, Montgomery K, Chi JT, Van De Rijn M et al. Gene expression signature of fibroblast serum response predicts human cancer progression: similarities between tumors and wounds. PLoS Biology 2004 2 (2): E7. 
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