Laceration Tear

A laceration is a tear of the skin. Depending on the amount of force used, the tear may be confined to the dermis or may extend through the full thickness of the skin.

An example of an injury confined to the dermis is overstretching (Fig 257-4). A full-thickness laceration extends into the subcutaneous tissue. When the injury is examined, bridging by intact blood vessels may be evident (Fi.9... .25.7.-5.). The resilience of elastic walled structures, such as arteries, allows them to maintain their integrity despite a blunt-force impact that tears the adjacent skin.

FIG. 257-4. "Overstretching" type laceration confined to the dermis.
FIG. 257-5. Full thickness laceration with "bridging by intact blood vessels.

Because a laceration is usually the result of a crushing force, the margins of the laceration will show the effects of the pressure crushing the epidermal layer or skin surface. Depending on the instrument causing the injury, a specific imprint may be evident when the margins of the laceration are reapposed. A laceration can also be called a tear but should never be called a cut, which implies the application of something other than blunt force. A common type of laceration occurs in protuberant areas of the body such as the elbow, knee, or eyebrow, where a fall against a hard surface such as a floor or pavement may result in the crushing of the skin against the underlying bone. Because the crushed skin margins may be nonviable, simple suturing of such a laceration without debridement will not result in healing by first intention.

Since lacerations often result from contact with a foreign object, residue from this object may be left within the wound. Recognition and recovery of particles of concrete, brick, or sand may be very helpful in the determination of whether an injury resulted from impact with an object such as a rock or the butt of a handgun ( Fig. 257:6). This information should be included in the description of the injury.

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