General Guideline Principles for Laceration Management
for workers compensation patients

The New York State workers compensation board has developed these guidelines to help physicians, podiatrists, and other healthcare professionals provide appropriate treatment for Laceration Management.

These Workers Compensation Board guidelines are intended to assist healthcare professionals in making decisions regarding the appropriate level of care for their patients with ankle and foot disorders.

The guidelines are not a substitute for clinical judgement or professional experience. The ultimate decision regarding care must be made by the patient in consultation with his or her healthcare provider.

Laceration Management of Hand, Wrist and Forearm Injuries

The main goals of wound and laceration management are to prevent infection, determine whether a nerve injury has occurred, treat tendon lacerations, and produce a result that is both functionally and cosmetically acceptable.

Diagnostic Studies of Laceration Management

1. Diagnostic Studies of Laceration Management X-Rays

   Diagnostic Studies of Laceration Management X-Rays is recommended if a radiopaque foreign body is suspected or for the evaluation of traumatic injury resulting in skin lacerations to rule out fracture.

    

2. Ultrasound of Laceration Management

   Ultrasound of Laceration Management is recommended as an alternative test when a radiopaque foreign body is suspected but not seen on x-ray images, or for evaluating suspected radiolucent materials.

    

3. CT of Laceration Management

   CT is not recommended for alleged surface foreign objects. It is advised- for the assessment of potential radiolucent materials and as a backup test when a potential radiopaque foreign body cannot be seen on ultrasound or x-ray images.

Medications of Laceration Management

Antibiotic Prophylaxis

Antibiotic Prophylaxis is not recommended for straightforward hand and forearm abrasions.

Non-Steroidal Anti-Inflammatory Drugs/Acetaminophen

For the majority of patients, older-generation NSAIDs like ibuprofen, naproxen, or are suggested as first-line treatments. Acetaminophen or an equivalent paracetamol) might make sense as a substitute for NSAIDs for patients who are not NSAID candidates, despite what the majority of evidence suggests Acetaminophen works slightly less well.

There is proof NSAIDs cause cancer. are less addictive than opioids (including tramadol) and equally effective at relieving pain impairing.

1. Non-Steroidal Anti-inflammatory Drugs (NSAIDs) for Treatment of Acute, Subacute, or Chronic Upper Extremity Post-Laceration Repair Pain

   Non-Steroidal Anti-inflammatory Drugs (NSAIDs) for Treatment of Acute, Subacute, or Chronic Upper Extremity Post-Laceration Repair Pain are recommended for the treatment of pain following upper extremity laceration repair that is acute, subacute, or chronic.

   Indications – NSAIDs are advised as a treatment for acute, subacute, or chronic upper extremity postlaceration repair pain. First, try over-the-counter (OTC) medications to see if they work.

   Frequency/Duration: Many Patients may find it reasonable to use as needed.

   Indications for Discontinuation: the symptom’s resolution, the medication’s ineffectiveness, or the emergence of side effects that require stopping.

    

2. NSAIDs for Patients at High Risk of Gastrointestinal Bleeding

   NSAIDs for Patients at High Risk of Gastrointestinal Bleeding is recommended for patients at high risk of gastrointestinal bleeding to take misoprostol, sucralfate, histamine Type 2 receptor blockers, and proton pump inhibitors concurrently.

   Indications: Cytoprotective drugs should be taken into consideration for patients with a high-risk factor profile who also have indications for NSAIDs, especially if a longer course of treatment is planned. Patients who have a history of gastrointestinal bleeding in the past, the elderly, diabetics, and smokers are at risk.

   Frequency/Dose/Duration: H2 blockers, misoprostol, sucralfate, and proton pump inhibitors are advised. dosage recommendations from the manufacturer. It is generally accepted that there are no significant differences in effectiveness for preventing gastrointestinal bleeding.

   Signals of Discontinuation NSAID intolerance, the emergence of negative side effects, or stopping use.

    

3. NSAIDs for Patients at Risk for Cardiovascular Adverse Effects

   The advantages and disadvantages of NSAID therapy for pain should be discussed with patients who have a history of cardiovascular disease or who have multiple cardiovascular risk factors.

    

   1. NSAIDs for Patients at Risk for Cardiovascular Adverse Effects

      NSAIDs for Patients at Risk for Cardiovascular Adverse Effects is recommended As far as adverse cardiovascular effects go, acetaminophen or aspirin as first-line therapy seem to be the safest options.

       

   2. NSAIDs for Patients at Risk for Cardiovascular Adverse Effects

      NSAIDs for Patients at Risk for Cardiovascular Adverse Effects is recommended If necessary, non-selective NSAIDs are preferred to COX-2-specific medications. To reduce the chance that an NSAID will negate the protective effects of low-dose aspirin in patients receiving it for primary or secondary cardiovascular disease prevention, the NSAID should be taken at least 30 minutes after or eight hours before the daily aspirin.

       

4. Acetaminophen for Treatment of Upper Extremity Post-Laceration Repair Pain

   Acetaminophen for Treatment of Upper Extremity Post-Laceration Repair Pain is recommended for the treatment of pain following upper extremity repair from lacerations, especially in patients who have NSAID contraindications.

   Indications: Acute, subacute, chronic, and post-operative patients with upper extremity post-laceration repair pain.

   Dose/Frequency: As per the manufacturer’s recommendations; can be used as required. Over four gm/day, there is evidence of hepatic toxicity.

   Indications for Discontinuation: relief from discomfort, negative effects, or intolerance.

    

5. Opioids of Laceration Management

   Opioids of Laceration Management is recommended for brief (less than seven-day) use as an adjunctive therapy to more potent treatments for the management of acute and post-laceration repair pain.

   Indications:In addition to more effective treatments (especially NSAIDs, acetaminophen, and elevation), a brief prescription of opioids is frequently needed for acute injury and post-operative pain management, especially at night.

   Frequency/Duration: As needed during the day, only at night later, and finally completely discontinued.

   Rationale for Recommendation: When NSAIDs are ineffective in relieving a patient’s pain, opioids should be used sparingly, especially at night. It is advised that patients who have undergone laceration repair use opioids sparingly and selectively, primarily at night to induce sleep.

Rehabilitation of Laceration Management

Rehab (supervised formal therapy) needed after a work-related injury should be concentrated on regaining the functional ability needed to meet the patient’s daily and work obligations and enable them to return to work, with the goal of returning the injured worker to their pre-injury status to the extent that is practical.

Active therapy calls for the patient to put forth an internal effort to finish a particular exercise or task. The interventions known as passive therapy rely on modalities that are administered by a therapist rather than the patient exerting any effort on their part.

Passive interventions are typically seen as a way to speed up an active therapy programme and achieve concurrently objective functional gains. Interventions that are active should be prioritised over those that are passive.

To extend the therapeutic process and maintain improvement levels, the patient should be advised to continue both active and passive therapies at home.

To facilitate functional gains, assistive devices may be used as an adjunctive measure in the rehabilitation plan.

Therapy: Active of Laceration Management

Therapeutic Exercise

Therapeutic Exercise is recommended for the treatment of lacerations-related functional deficits.

Frequency/Dose/Duration –With documentation of ongoing objective functional improvement, the total number of visits may be as low as two to three for patients with mild functional deficits or as high as 12 to 15 for those with more severe deficits.

When functional deficits persist, more than 12 to 15 visits could be suggested if there is proof of functional development with a specific goal in mind (e.g., improved range, key pinch strength, and grip of motion, improving capacity to carry out work-related activities).

Part of a component of the treatment strategy, a home exercise routine should be created and carried out in conjunction with the treatment.

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