From the Guidelines
After a laceration repair in the ER, it is essential to provide patients with clear discharge instructions to ensure proper wound healing and prevent complications, as emphasized in the most recent guidelines 1. When discharged from the ER after a laceration repair, patients should be given specific instructions on wound care, pain management, and follow-up appointments.
- Keep the wound clean and dry for the first 24-48 hours, then gently clean the area daily with mild soap and water, pat dry, and apply a thin layer of antibiotic ointment like Bacitracin or Neosporin before covering with a fresh bandage.
- Change the bandage daily or when it becomes wet or dirty.
- Take pain medication as prescribed, typically acetaminophen (Tylenol) or ibuprofen (Advil, Motrin) for mild to moderate pain, as recommended in the latest study 1.
- Watch for signs of infection including increasing redness, warmth, swelling, pus, foul odor, fever, or worsening pain.
- Sutures typically need removal in 5-14 days depending on the location (face: 3-5 days; scalp: 7-10 days; trunk/extremities: 10-14 days).
- Limit activities that could stress the wound until healing occurs.
- Avoid submerging the wound in water (baths, pools, hot tubs) until sutures are removed or your doctor advises it's safe.
- After healing, protect the scar from sun exposure with sunscreen or clothing for at least 6 months to prevent darkening. It is also crucial to inform the patient's general practitioner promptly of the type of treatment given, the surgical procedure performed, and the postoperative instructions given, as highlighted in the guidelines 1. Additionally, patients should be given a copy of their discharge summary and have access to a helpline for at least the first 24 hours after discharge, and arrangements should be made for telephone follow-up the next day, as recommended in the study 1.
From the Research
Laceration Repair Discharge Instructions from ER
- The use of prophylactic antibiotics in simple hand lacerations is not well established, with varying practices among physicians 2.
- A study comparing 2-day and 5-day prophylactic antibiotic therapy in contaminated traumatic wounds found no significant difference in infection rates between the two groups 3.
- Topical antimicrobials, such as mupirocin cream, have been shown to be as effective as oral cephalexin in treating secondarily infected wounds 4.
- Noninvasive wound closure devices, such as the Zip Closure device, may offer a fast and easy alternative to traditional wound repair methods, with potential cost savings and improved patient satisfaction 5.
- The use of prophylactic oral antibiotics for intraoral wounds is not well supported by evidence, with some studies suggesting that careful wound preparation and routine oral and local wound care may be sufficient 6.
Key Considerations for Discharge Instructions
- Patients should be informed about the signs of infection, such as erythema, purulent discharge, and inflammation, and instructed to seek medical attention if they occur 2, 3.
- Wound care instructions should include keeping the wound clean and dry, and changing dressings as needed 5.
- Patients should be advised to follow up with their healthcare provider to assess wound healing and remove any closure devices or sutures 5.
- The use of prophylactic antibiotics should be individualized based on the patient's specific condition and medical history, and in accordance with evidence-based guidelines 2, 3, 6.