What is the appropriate management for a skin laceration with jagged edges?

Management of Skin Lacerations with Jagged Edges

For jagged-edged lacerations, debride the irregular wound margins to create smooth, linear edges before closure, then repair using layered technique with deep dermal sutures for strength and superficial sutures for cosmetic approximation. 1, 2

Initial Wound Assessment and Preparation

Wound Preparation:

• Irrigate thoroughly under pressure with potable tap water or sterile saline—both are equally safe and effective 3
• Examine the wound depth to determine if layered closure is needed 1
• Obtain radiographs if foreign body or underlying structural injury is suspected 1
• Ensure adequate anesthesia using local infiltration (epinephrine-containing anesthetics are safe even in digits at 1:100,000 concentration and in nose/ears at 1:200,000) 3
• Use nonsterile gloves—they do not increase infection risk compared to sterile gloves 3

Debridement of Jagged Edges

The critical step for jagged lacerations is converting irregular margins into smooth, linear edges:

• Use dissecting forceps and scalpel to debride devitalized and irregular tissue 2
• Bevel the skin edges slightly during preparation to ensure precise approximation 4
• Remove minimal tissue—only enough to create clean, linear margins that can be accurately approximated 2, 4
• Avoid excessive debridement that creates unnecessary tissue loss 4

Layered Closure Technique

The dermis provides the skin's tensile strength, making layered closure essential:

• Deep layer: Place buried dermal sutures using absorbable material (polyglactin 910, poliglecaprone, or polyglyconate) to approximate the full thickness of dermis to opposite dermis 1, 5
• Undermine the wound edges with even thickness, especially at margins, to reduce tension 4
• Superficial layer: Use interrupted or continuous subcuticular sutures for epidermal approximation—this provides cosmetic benefit but does not contribute to wound strength 1, 5
• Consider monofilament sutures as they cause less bacterial seeding than multifilament 6

Alternative Closure Methods

For low-tension areas with minimal jaggedness after debridement:

• Tissue adhesives can be used if wound edges are linear and under minimal tension 3, 5
• Skin adhesive strips (Steri-Strips) are appropriate for facial lacerations in low-tension areas 7, 5
• These alternatives provide similar infection rates and scarring outcomes while reducing procedure time and pain 3, 5

Post-Repair Management

Wound care:

• Apply occlusive or semiocclusive dressings—wounds heal faster in moist environments 3
• White petrolatum ointment is as effective as antibiotic ointment for postprocedure care 5
• Wetting the wound after 12 hours does not increase infection risk 5
• For high-tension areas or wounds near joints, immobilize with splint or sling 1

Follow-up:

• Examine wound 2-3 days after repair for signs of infection (increasing pain, erythema, swelling, or discharge) 1
• Remove sutures based on location: facial wounds at 5-7 days, high-tension areas like anterior tibia at 14 days 7
• Provide tetanus prophylaxis if indicated 3

Critical Pitfalls to Avoid

• Do not attempt primary closure of jagged edges without debridement—irregular margins prevent accurate approximation and increase scarring risk 2, 4
• Do not place sutures through fat or muscle—these tissues do not support sutures effectively 1
• Do not use full-thickness sutures except on palmar/plantar surfaces where skin is thicker 1
• Do not delay closure excessively, but note there is no absolute "golden period"—wounds can often be safely closed 18+ hours after injury depending on contamination level 3