Last Updated on Wednesday, 16 December 2015 16:05
By Dr. Rob LaPrade
http://drrobertlaprademd.com
Question: I cut my chin when my helmet rode up on my face during a game. I used a butterfly band-aid to close the cut but was told later that I should have gone to the doctor to have it sutured. What is the proper treatment for this type of cut?
Answer: Based on the advice you received about having the cut sutured, it sounds like you sustained a laceration that entered into the deeper layers of the skin. When evaluating a cut, we tend to make treatment recommendations based on how deeply a laceration (cut) extends into the dermal skin layers.
The most superficial dermal injuries are abrasions – scrapes that scuff off the surface layer of the skin and may cause some bleeding. Treatment of these injuries generally involves covering the abrasion to prevent bleeding and exposing other players during practice or competition. Abrasions often heal relatively quickly.
Superficial lacerations (cuts) extend through only the surface layer of the skin. When attempting to pull the skin margins apart, there is very little spreading that occurs because the deeper skin layers are still intact. For these superficial lacerations, it would be appropriate to use a band-aid, butterfly band-aid, steristrip, or other adhesive material to cover the lesion and hold the skin edges together for a couple of days until the cut heals. In all cases, the wound should be thoroughly cleaned to make reduce the risk of infection. Finally, it is imperative to make sure that you have had a tetanus vaccination within the last ten years whenever you have a laceration that punctures the skin.
For lacerations that extend into the deeper layers of the skin, it is more important to obtain a tight seal and to keep the edges of the cut skin pulled together to allow for a quicker healing time. Although some types of skin glue have been developed to hold the edges of deep lacerations together, the traditional form of treatment for this type of laceration is to use stitches to hold the cut skin edges together. The stitches help to decrease the chance of infection, allow for a quicker healing time, and often leave a smaller scar.
Steristrips or a butterfly band-aids may be appropriate for a brief period of time until stitches can be placed by a medical professional. At that point, a doctor can assess the extent of the injury and recommend an appropriate treatment. For hockey players specifically, steristrips or butterfly band-aids often fail to hold even small lacerations together because of the large amounts of perspiration produced while playing hockey. This will often cause the adhesive tape to prematurely detach from the skin.
In summary, begin treating a facial laceration by thoroughly cleaning out the cut to minimize the risk of infection. Superficial abrasions can be covered with bandaids until the wound heals. Small cuts in the surface layer of the skin that do not spread apart when pulled at its edges can be treated with a band-aid or other adhesive products. Deeper cuts where the skin edges spread apart should be evaluated by a physician or other medical personnel to determine if stitches are necessary. Finally, anytime the skin is punctures, it is improtant make sure your tetanus vaccination is up to date.
Robert F. LaPrade, M.D., Ph.D. is a complex knee surgeon at The Steadman Clinic in Vail, Colorado. He is very active in research for the prevention and treatment of ice hockey injuries. Dr. LaPrade is also the Chief Medical Research Officer at the Steadman Philippon Research Institute. Formerly, he was the team physician for the University of Minnesota men’s hockey team and a professor in the Department of Orthopaedic Surgery at the U of M. If you have a question for the Hockey Doc, e-mail it toeditor@letsplayhockey.com.
