As a general rule, crushed tissue should be excised. Crushed tissue leads to additional edema, fibroplasia, and more scarring. Ihe extent of crushed tissue may not be easily visible. One way to demonstrate the extent of crushed tissue is to use hydrogen peroxide, which will produce a white patch wherever the wound edges were crushed. However, full excision of all crushed tissue may create more problems in the long run, particularly if excision will leave defects that cannot be covered with available skin. During the repair of traumatic lacerations in the ED, excision should be limited and completely avoided on the nose, vermilion-cutaneous junction, or eyelid. Wounds in these areas should be closed while preserving as much tissue as possible. Ihe most important principle in repairing crushed tissue is to do most of the work at the subcutaneous level and use very few percutaneous sutures. Another principle is to position the pieces so that they heal in proper relation to each other so that scar revision, if necessary, will be easier. With all crush injuries, the patient should be warned about the possibility of a residual scar but also informed that plastic surgery revision is an option.
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