JJ 23 Laceration Aftercare – Dressings, Antibiotics, Improving Cosmesis, Preventing Infection

In this Part 3 of our 3-part podcast series on management of lacerations Dr. Haley Cochrane joins Anton and Justin to explore laceration aftercare and the evidence for keeping wounds dry or wet, wound dressings, topical antibiotics, prophylactic oral antibiotics, Vitamin E oil, aloe vera cream and UV protection with regards to cosmetic outcomes and infection rates. What may be the most important aspect of aftercare is educating the patient what to expect as the laceration heals and when they should seek medical attention... Podcast production, sound design & editing by Anton Helman Written Summary and blog post by Anton Helman February, 2023 Cite this podcast as: Helman, A. Morgenstern, J. Cochrane, H. Laceration Aftercare - Dressings, Antibiotics, Improving Cosmesis, Preventing Infection. Emergency Medicine Cases. February, 2023. https://emergencymedicinecases.com/laceration-aftercare. Accessed September 17, 2024 Laceration aftercare question 1: Is it best to keep the wound dry or let it get wet? * Two small RCTs from the 1980's showed no difference in infection rates when comparing keeping wounds dry vs wet. * A 2006 unblinded RCT of 870 family practice patients after simple skin excision randomized to 48hrs dry vs 12hrs dry followed by regular cleaning with soap and water showed no difference in infection rate. Bottom line: the literature does not give us a clear answer to whether wounds should be kept dry or not. Commentary: common sense would dictate that removing the dressing regularly to check for signs of infection and cleaning with soap and water is preferred over leaving a dressing on without checking it for signs of infection or cleaning the wound. Laceration aftercare question 2: Do wound dressings help with laceration healing or prevent infection? * There are no ED-based studies looking at laceration wound dressings. * A Cochrane review of dressings after surgery for prevention of infection concluded that there is no good evidence that one dressing is better than another and based 2 low quality RCTs comparing dressings to no dressings, that there was no difference in infection rates. * Another Cochrane review based on 3 studies comparing early vs late removal of dressings from clean or contaminated surgical wounds found no difference in infection rates. Bottom line: there is no good evidence to guide us as to whether dressings are of benefit or not for lacerations. Commentary: common sense would dictate that using a dressing for the first few hours to prevent clothes getting blood on them is reasonable, that for patients working in environments where wound contamination is likely, that keep the wound covered during work is reasonable, and that for patients who live in dry climates, that petroleum jelly (petrolatum) applied to the wound is reasonable to prevent skin cracking/bleeding. For wounds under high tension in physically active patients, a splint-type dressing is a consideration as well. Laceration aftercare question 3: Do topical antibiotics help prevent infection? A 1995 double-blind RCT of 465 patients in a single center military hospital were randomized to receive bacitracin, neomycin/bacitracin/polymyxin B, silver sulfadiazine or placebo. Simple stitch abscesses that did not require any management were found in 6%, 5%, 12% and 18% respectively. There was one patient with an allergic reaction. Bottom line: there is evidence to suggest that topical antibiotics decrease the risk of insignificant simple stitch abscesses that do not require any change in management or have any significant impact on patient outcomes. Laceration aftercare question 4: Which lacerations require prophylactic oral antibiotics? * A 2001 Cochrane Review of 8 RCTs found that prophylact...