Cuts and Lacerations

A laceration is a wound that is caused by tearing of soft tissue. Lacerations to the face and scalp often happen during a match.

Classification

Simple lacerations

  • Edges easily lined up.
  • Uncontaminated by foreign material or bites.
  • Less than 3cm long or 0.5cm wide.
  • Do not have any features of complicated lacerations.

 

 

Complicated lacerations

  • Have jagged edges.
  • A deep wound where the different layers need to be sutured or stitched.
  • May be contaminated with dirt.
  • Have underlying fractures of the facial bones.

 

 

FIRST AID

  • Apply ice and pressure to reduce swelling.
  • Control bleeding with sterile gauze.
  • Remove any player with a bleeding wound from the field of play immediately.

 

Management

  • Examine laceration closely under good light.
  • Clean wound and remove foreign bodies as necessary.
  • Local anaesthetic (1-2% lignocaine with adrenaline) may be used to facilitate adequate cleaning.
  • Small wound can be controlled with local pressure.
  • Lacerations greater than 0.25-0.5cm long should be closed if they appear clean.
  • Closure may be achieved using sutures or adhesive strips (Steri-Strips).
  • Steri-Strips are thin adhesive strips designed to pull the edges of wounds together and are considered ideal for small wounds.
  • A tincture of benzoin may be put on intact skin around the laceration to help the Steri-Strips stick to skin.
  • Adequate dressing will be required to keep the adhesive strips in place, particularly if the player is returning to the field.

Sutures

  • Larger lacerations will require suturing (stitches) by a doctor.
  • Skin edges must be healthy and devitalised skin should be debrided (cleaned).
  • Skin edges must be aligned carefully.
  • As a general rule, 3-0 or 4-0 sutures are appropriate on the trunk, 4-0 or 5-0 on the extremities and scalp and 5-0 or 6-0 on the face.
  • Lacerations of the eyebrow and lip require strict anatomical approximation.
  • Remove sutures after five days and place adhesive strips over the wound for a further week.

General Principles for First Responders

  • “Gaping” wounds (>0.5cm wide) will tend to dehisce (burst apart) if managed with Steri-Strips alone.
  • Eyebrow lacerations which cross the eyebrow vertically are at risk of poor alignment and may require referral to hospital.
  • Scalp wounds often bleed profusely and may require suturing.

Simple lacerations of the lip will heal on their own. Send the player to hospital if there is significant disruption of the lip border.

  • Lacerations on the eyelid should be closed with Steri-Strips.
  • Some small wounds (in particular chin lacerations) may be slightly jagged, but nevertheless align well and can thus be managed with glue and or Steri-Strips.