A laceration is a type of damage to the skin, soft tissues or mucous membranes that occurs under the influence of a heavy, blunt object. A distinctive feature is a rupture of the epidermis with uneven ends. It is characterized by detachment of tissue flaps, scalping of the pathological area with subcutaneous fat.
What is a laceration and what does it look like?
According to ICD-10, mechanical injury with rupture of soft tissues can occur as a result of household injuries, a car accident, a fall from a bicycle, motorcycle, or from a great height. A lacerated wound is characterized by intense bleeding, skin detachment - partial or complete separation of the epidermis. The condition may be accompanied by impaired sensitivity of nerve endings in the affected area - paralysis, neuralgia.
Often a lacerated wound is limited to a rupture of the skin and subcutaneous tissue.
According to the ICD, when localized in the upper and lower extremities, ruptures of muscles, nerve fibers, and vessels of different sizes can be observed.
In case of a head injury, the damaged tissues move little and heal well. A recovery process without complications is possible provided there is no pathological area with a deep incision. Renewal is facilitated by rich vascularization, but this factor can cause severe venous bleeding.
Laceration
Distinctive features of lacerated wounds are patchy edges of irregular shape, significant tissue damage in the walls of the wound channel, tissue detachment, and areas of skin scalping. The formation of a tissue defect due to their complete separation is possible. The depth of the wound channel is, as a rule, insignificant, while the affected area can reach large sizes in length and width. Bleeding is less than with cut wounds. Fabrics are often heavily contaminated, which is facilitated by the mechanism of injury: damage from dirty garden tools, falling from a bicycle or motorcycle onto asphalt or gravel, falling onto pieces of coal when working in a mine, etc.
Types of lacerations include crushed, bruised and scalped injuries. With crushed and bruised wounds, extensive destruction and necrosis of tissue is observed. Scalp wounds are characterized by partial or complete separation of the skin from the underlying tissue without significant destruction. Scalped injuries to the scalp can occur when hair gets into moving mechanisms, scalped wounds of the lower and upper extremities - when they get under the wheels of a vehicle or into rotating mechanisms. Injuries caused by contact with moving mechanisms can also cause open fractures and traumatic amputations.
Due to the large area of damage and tissue necrosis, lacerated wounds heal worse and fester more often than incised wounds. Healing by secondary intention or under a scab is typical. Healing by primary intention is possible in favorable circumstances: with a small amount of damage, a relatively small area of necrosis, the absence of gross defects of the skin and soft tissues, minor microbial contamination and a good state of the immune system.
Infection in lacerated wounds develops faster than in stab or cut wounds. The first signs of infection (swelling, hyperemia of the edges, sanguineous or mucous discharge) can be detected within a few hours after the injury, while in incised wounds the infection usually develops about a day after the injury. This necessitates early seeking medical help and further worsens the prognosis.
The wound process occurs in three stages. At the inflammation stage, necrotic tissue is destroyed and removed from the wound along with pus. Initially, the surrounding tissues swell, the lumen of the canal narrows or disappears, and blood clots and dead areas are “squeezed out” out. Then the inflammation becomes purulent. The remaining dead tissue is melted. A demarcation shaft is formed around the damaged area, separating necrotic tissue from healthy tissue.
After complete cleansing, the regeneration (recovery) phase begins, during which granulation tissue forms on the canal walls. Granulations gradually fill the entire defect and become denser. Then comes the epithelization phase, ending with the formation of a scar. With extensive soft tissue defects, independent healing becomes impossible; granulations have to be closed using skin grafting. The duration of each healing phase depends on the size of the damage, the degree of bacterial contamination, the amount of necrotic tissue, the presence of other traumatic injuries and somatic diseases, etc.
What lacerations are there and their ICD 10 code
Types of laceration injuries by location, according to the ICD:
- There are cases where the wound of the head and neck is torn. When the eye is damaged, the upper or lower eyelid ruptures with intense bleeding and the intraocular angle ruptures. Eyeball prolapse is a condition aggravated by complications. When falling from a height, wounds are formed on the face located in the oral cavity with the lip torn off and the dentition exposed with constant drooling, and patchy injuries to the forehead and chin occur. The medical examiner notes frequent cases of lacerations in the nose and ears.
- According to ICD-10, an affected cavity formed on the leg is a violation of the integrity of the skin of the thigh and lower leg. Characterized by a rupture of the knee with damage to the joint. The condition is accompanied by cut tendon injuries and sagging of the foot.
- Pathological area localized in the arm area - isolated injuries to the forearm, hand, fingers with nail separation according to the ICD.
Depending on the shape, width, length, depth of the wound, and the presence of infection, the severity of the laceration is distinguished.
In medicine, an international classification is used to designate diseases. The condition belongs to the category of open pathological areas, presented in subparagraphs S00-T98. Lacerated wounds of the leg and forearm have ICD 10 codes S81 and S51, respectively.
Brushes
The danger of hand injury lies in impaired movement. The condition is aggravated by tendon rupture, and partial paralysis of the arm or fingers may occur. When struck with a blunt object, part of the phalanx may be lost or the nail bed may be crushed.
Timely consultation with a doctor and provision of first aid is the key to successful treatment and quick recovery. After the formation of a laceration, it is necessary to eliminate the impact of traumatic force.
To avoid consequences, you should go to the hospital. The prognosis for recovery increases, the risk of complications will decrease.
The diagnosis is made by a doctor based on examination. The description of the pathology and designation in accordance with the classification are recorded in the patient’s medical record according to the code. ICD 10 code for laceration of the hand and wrist is S61.
Treatment of minor injuries is carried out in an emergency room or on an outpatient basis. The doctor performs primary surgical treatment:
- Disinfection of torn pathologies with antiseptics to remove dirt.
- Stop bleeding using tamponade, using diathermoelectrocoagulation of small vessels or applying a vascular ligature.
- If necessary, foreign bodies - fragments - are removed.
- Excision of necrotic tissue.
- Purulent lacerations are treated and drainage is installed. Sutures can be placed only after the exudate has been completely removed.
- Apply sutures to the damaged surface for up to 10-14 days.
- Application of a sterile dressing.
In case of significant injuries with heavy bleeding, the following medical care algorithm should be followed:
- Hemostasis is stopping bleeding in the area of a laceration.
- Intravenous injections of drugs to replenish the level of blood volume.
- Hospitalization of the patient in a hospital - surgery, traumatology.
- Restoration of the anatomical integrity of the damaged area of skin with reposition of the flap or phalanx that is torn off. If necessary, tissue from other parts of the body is used to close the defect - thigh, lower leg through surgical correction.
- Prescribing antibiotic therapy during and after surgery to prevent suppuration.
Sick leave is issued for the entire recovery period. The home regime lasts for 1 month. Time is necessary for complete healing of lacerated wounds and restoration of performance.
Shin
According to ICD-10, an open wound of the leg has the code S81.
If there is significant damage to the lower leg, suppuration may occur. In case of deep injury in combination with affected muscles and nerve fibers, severe pain is noted, radiating to the feet and thigh. Stiffness of movement appears; with tendon pathology, there is a risk of foot sagging with subsequent disability.
Treatment of a laceration in the shin area can be done at home if the damage is minor:
- if there is bleeding, you need to raise your leg and apply a pressure bandage or tourniquet, recording the time and immediately contact a medical facility or call an ambulance for hospitalization;
- the lacerated wound must be washed with an antiseptic solution - hydrogen peroxide, Chlorhexidine;
- apply a sterile dressing;
- If there is a bone fracture, you need to apply a splint using improvised means until doctors arrive.
Hips
According to ICD-10, lacerations of the thigh are coded S71.7. The danger of the condition in the area of the hip joints is caused by the following factors:
- Nearby large vessels - inguinal veins, arteries. If a rupture occurs, there is a high probability of death due to severe bleeding.
- Suppuration of a lacerated wound involving the reproductive organs.
- The risk of blood poisoning, which is due to the good vascularization of the femoral area.
- Damage to nerve fibers can lead to complete paralysis of the legs.
Treatment is carried out exclusively in a hospital setting with surgery to restore the pathological limb.
Heads
According to ICD-10, lacerated head injuries are characterized by good healing. The condition is typical for motorcyclists and cyclists. The damage is caused by a fall and further damage to the integrity of the scalp and face.
Wounds on the forehead and chin occur due to secondary tension and scalping of part of the skin. Treatment boils down to repositioning tissue flaps, disinfecting the area, suturing and antibacterial therapy.
Damage to the lips with separation of part of the soft tissue is corrected by applying sutures and restoring the border.
The mouth may not open due to the formation of a hematoma. When a part of the skin with the lip is torn off, the dentition is exposed, which threatens the development of infection and disruption of the microflora of the mouth with constant salivation into the torn cavity. The ICD 10 code for wounds of the lip and mouth is S01.5.
Wounds of the nose and ears are more serious; if the cartilage is damaged, plastic surgery using autologous materials or artificial implants may be required.
According to ICD-10, lacerated eye damage is considered dangerous due to the risk of injury to the eyeball. There is a risk of visual impairment or blindness. If the upper and lower eyelids are torn off at the same time, complete loss from the orbit is possible. Doctors treat a lacerated wound; self-medication is unacceptable. The operation is performed by ophthalmological surgeons.
Forearms
The types of injuries in the arms are similar to those in the legs. Medical tactics are no different. The danger of lacerations in the shoulder and forearm lies in the location of large vessels and nerve fibers. With massive injuries, severe bleeding and paralysis of the limb are noted.
Puncture wound
At the prehospital stage, in case of mild bleeding, the skin around the wound should be washed and disinfected, and then a sterile bandage should be applied. In case of massive bleeding, it is necessary to use one of the methods to temporarily stop the bleeding (apply a tourniquet or a pressure bandage, perform wound tamponade). If a sharp object (pin, sharpening) remains in the wound, it should not be removed, as this may lead to increased bleeding and the development of shock. All patients with puncture wounds must be immediately evacuated to a specialized medical facility.
Orthopedic traumatologists treat fresh puncture wounds without damaging internal organs. Patients with suspected damage to internal organs, nerves and blood vessels are referred to the appropriate specialists: thoracic surgeons, abdominal surgeons, cardiac surgeons, urologists, vascular surgeons, neurosurgeons, etc. Treatment of infected puncture wounds is carried out by surgeons.
In the presence of a fresh, uncomplicated puncture wound, PSO is indicated, which is usually performed under local anesthesia. The doctor rinses with solutions of peroxide and furatsilin, examines the wound canal with a finger or probe,, if possible, excises contaminated areas and sutures the tissue layer-by-layer. To improve outflow, puncture wounds must be drained with half-tubes or rubber outlets. Drains are removed 1-3 days after surgery, sutures are removed on days 8-10.
Patients with deep wounds, muscle damage and significant blood loss should be hospitalized in the trauma department. For minor soft tissue injuries, outpatient treatment at the emergency room is possible. In the postoperative period, UHF and antibiotic therapy are prescribed.
Damage to an internal organ is an indication for appropriate abdominal surgery. If the lung is injured, a thoracotomy is performed, if the abdominal organs are damaged, a laparotomy is performed, etc. The doctor carries out an inspection, suturing the damaged organ and performs other therapeutic measures (the list of measures and tactics of surgical treatment depends on the characteristics of the wound). All patients with damage to internal organs are hospitalized.
Infected wounds are opened, washed and drained. Local treatment is carried out against the background of antibiotic therapy. First, broad-spectrum antibiotics are used, then the drug is prescribed taking into account the sensitivity of the detected microorganisms. Depending on the patient’s condition, treatment can be either inpatient or outpatient.