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Provider Prepared’s Weekly Pearl of Wound Wisdom #28 Tongue Lashing 0

A 3 year old male is brought to the emergency department for repair of a tongue laceration. As he was playing with older siblings, he fell forward striking his chin on the floor causing him to bite his tongue. He suffered a laceration across the full width of his anterior tongue, that is gaping with on going active bleeding.

Repair of tongue lacerations should be considered when the laceration is greater than one centimeter, extends into muscular layers or that are full thickness. Additionally repair should be considered when the lateral border of the tongue is involved, if large gaping of the wound is present, or flaps are created by the wound.

Tongue wounds that are less than one centimeter and non-gaping, without previously mentioned anatomical involvement, typically do not need repair.
When repair is indicated, absorbable suture material that is 3-0 or 4-0 should be used.
Jasper, JI et al. Evaluation and repair of tongue lacerations. UpToDate June 2017.

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Nathan Whittaker, MD

Provider Prepared’s Weekly Pearl of Wound Wisdom #27 Soccer cleat to the ear! 0

A 20-year-old male presents to the emergency department with extensive wound to his left ear which occurred while playing an aggressive soccer game.  Another player's soccer cleat became caught in the patient's ear gauge creating extensive auricular injury.

Complex auricular lacerations are those that expose the cartilage or extend through the cartilage. These wounds require very careful and detailed closure. In general, sutures should not be passed through the cartilage itself. In order prevent notching or a step-deformity, the perichondrium must be reapproximated. The cartilage must also be covered with skin for appropriate cosmetic repair.

The skin of the ear is so thin and firmly adhered to the perichondrium, stitches that simultaneously reapproximate both layers are acceptable. The perichondrial layer should be the deepest layer of sutured tissue.If absorbable suture is used, it should not be dyed material to avoid tattooing of the repaired tissue.
Malloy, KE et al. Assessment and management of auricle lacerations. UpToDate, November 2016

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Nathan Whittaker, MD

Provider Prepared’s Weekly Pearl of Wound Wisdom #26 Lend me your Ear 0

A 40 year old female presents to the emergency department with a superficial laceration to the upper part of her right ear.  This laceration was created as she was struck by a tree branch while doing yard work at her home this afternoon.

Simple lacerations of the ear are those that spare the cartilage. The most common location for a simple laceration of the ear is the ear lobe. These are appropriately closed with 6-0 nonabsorbable suture.

A 6-0 absorbable suture is reasonable to use in young children and in patients without certain follow up for suture removal. Most experts recommend fast-absorbing gut, as the absorbable suture material.

Auricular anesthesia can be obtained with local injection of Lidocaine without epinephrine, or by regional auricular block using Lidocaine with epinephrine.
Malloy, KE et al. Assessment and management of auricle lacerations. UpToDate, November 2016.

This patient's laceration did not have involvement of the cartilage, it was easily repaired with 6-0 prolene in a simple interrupted fashion.

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Nathan Whittaker, MD

Provider Prepared's Weekly Pearl of Wound Wisdom #25 To air or not to air? 0

After excellent closure of a scalp wound, those closed with staples or nonabsorbable sutures can be left open to air. After 24-48 hours, they should be gently cleansed with soap and water. 

Wounds that are small and superficial, requiring only a few staples or sutures for closure, can have suture or staple removal in 7-10 days. Larger more complex wounds should be considered for suture or staple removal after 10-14 days.

Hollander, JU et al. Assessment and management of scalp lacerations. UpToDate February 2018.

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Nathan Whittaker, MD

Provider Prepared’s Weekly Pearl of Wound Wisdom #24 Gashing Galea! 0

A 32-year-old male presents to the emergency department with a laceration to the forehead extending up into the hairline. This occurred after a cut off wheel on a 7 inch grinder flew apart, and a portion of the cut off wheel impacted him in the head creating this laceration.

Assessment of scalp lacerations should also include assessment of all of the deep tissues. The galea is the connective tissue layer against the bone. This needs to be assessed to determine if there is presence of a galeal laceration. Lacerations of the galea larger than 0.5 cm should be repaired. Literature recommends using 3-0 or 4-0 absorbable suture material in the galea.

Repair of the galea helps prevent development of subgaleal infections, and subgaleal hematoma. Repairing galea lacerations also protects anchoring of the frontalis muscle, which has cosmetic implications.
Hollander, JU et al. Assessment and management of scalp lacerations. UpToDate February 2018.

This patient’s wound did involve the galea. A complex three layer repair was performed with excellent cosmetic outcome.

Visit here: Provider Prepared to see your options to be affordably and honestly prepared for all your wound care needs at home and on the go!

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Nathan Whittaker, MD

Provider Prepared’s Weekly Pearl of Wound Wisdom #23 Hook, line and sinker! 0

A 7 year old male is brought into the Emergency Department with a fish hook stuck in the bottom his left foot. He apparently stepped on the hook when it was accidentally left on the floor of his family’s home.

There are several techniques for fish hook removal. Among these are: the back out technique, the push through technique, needle technique, string technique. If these techniques fail then as a last resort the hook is cut out. Our preferred technique is the push-through technique, described as follows:

After anesthetizing the the area, using a hemostat the hook is advanced until the barb is exposed. Wire cutters are used to cut the barb off, wear eye protection while doing so. The reminder of the hook is then backed out of the wound. The resultant injury is then treated as a puncture wound.
Bothner, JO et al. Fish-hook removal techniques. UpToDate, November 2016.

This patient tolerated the push-through technique without any complications.

Provider Prepared’s laceration kits give you the capability and portability to remove fish hooks anytime anywhere.

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Nathan Whittaker, MD