Management of Wide Lacerations

Initial Assessment and Preparation

• The American College of Obstetricians and Gynecologists recommends ensuring adequate lighting and anesthesia before attempting any repair, using local infiltration with lidocaine (with or without epinephrine up to 1:100,000 concentration for digits) or considering regional/general anesthesia for extensive wounds 1

Techniques for Wide Lacerations

• The American College of Obstetricians and Gynecologists suggests placing deep dermal sutures using absorbable monofilament material (poliglecaprone or polyglyconate) to reduce surface tension and support the wound infrastructure 2

Alternative Closure Methods

• The American College of Obstetricians and Gynecologists recommends using tissue adhesives (cyanoacrylate) for low-tension areas where edges can be approximated to within 5mm, as they provide equivalent cosmetic outcomes with less pain and faster application time compared to sutures 2, 3

Common Pitfalls

• The American College of Obstetricians and Gynecologists advises against attempting to close wounds under excessive tension, as this leads to tissue ischemia, necrosis, and dehiscence 4