Skin/Soft Tissue

  • Hair Tourniquet Management
  • Laceration Repair (Nail Bed)
  • Laceration Repair (Tongue)
  • Ring Removal
  • Subcutaneous Abscess I&D
  • Subungual Hematoma Evacuation
  • Stapling (General)
  • Suturing (General)
  • Tissue Adhesives (General)
  • Trigger Point Injections

Hair Tourniquet Management

Rapid Review

  • Background
    • Hair tourniquets occur when hair, thread, or other thin materials becomes tightly wrapped around an appendage (toe, wrist, penis, scrotum, tongue) and results in pain or injury. Can be removed using the unwrapping method, cutting method, or depilatory method
  • Indications
    • All cases of hair tourniquets should be managed
  • Contraindications
    • No contraindications. 
  • Complications
    • Bleeding, infection. Incisional approach may damage underlying structures of affected site. 

Pearls

Video Credit: Larry Mellick


Laceration Repair (Nail Bed)

Rapid Review

Pearls

Deep Dive

Video Credit: Brian Lin


Laceration Repair (Tongue)

Rapid Review

  • Background
    • Tongue lacerations can occur as the result of falls, blunt/penetrating, seizures, etc. Due to general blood supply, most tongue lacerations do not require repair unless they exhibit complex features.
  • Indications
    • Bisecting wounds, large flaps, U-shaped, gaping, or avulsion
  • Contraindications
    • Amputations or avulsions of more than 30% (requires flap procedure by specialist).
  • Complications
    • Infection, hemorrhage, airway compromise, disfigurement

Pearls

Video Credit: EM:RAP


Ring Removal

Rapid Review

Pearls

Deep Dive

Video Credit: Larry Mellick


Subcutaneous Abscess I&D

Rapid Review

  • Background
    • Due to inability of antibiotics to penetrate the abscess cavity, subcutaneous abscess must be drained for complete resolution. 
  • Indications
    • Abscess of the skin or superficial soft tissue
  • Contraindications
    • No absolute contraindications. Deep/large abscesses or abscesses in highly cosmetic areas may require operating room management.
  • Complications
    • Infection, damage to surrounding structures.

Pearls

Video Credit: Core EM


Subungual Hematoma

Rapid Review

  • Background
    • Also known as “nail bed trephination”. Involves draining blood from underneath the nail to relieve pain and discomfort
  • Indications
    • Painful subungual hematoma with nail edges intact
  • Contraindications
    • If the wound is not painful or is already spontaneously draining. Do not evacuate hematoma if nail removal is already indicated for complex nail bed lacerations. Do not use electrocautery tool on acrylic nails (may be flammable)
  • Complications
    • Injury to nail bed, infection, or incomplete drainage

Pearls

Video Credit: EM:RAP


Stapling (General)

Rapid Review

Pearls

Deep Dive

Video Credit: MiniMedLessons


Suturing (General)

Rapid Review

  • Background
    • Suturing lacerations helps facilitate biological healing by joining wound edges and minimizing scar formation. There are various techniques of suturing, depending on the size, shape, and depth of the wound.
  • Indications
    • Clean lacerations that have occurred within 24 hours and not at significant risk for infection.
  • Contraindications
    • Dirty wounds, body lacerations >12 hours old, face/scalp wounds > 24 hours old
  • Complications
    • Hematoma, infection, hypertrophic scarring, wound dehiscence

Pearls

Video Credit: Dr. Zenn


Tissue Adhesives (General)

Rapid Review

Pearls

Deep Dive

Video Credit: Ethicon


Trigger Point Injections

Rapid Review

Pearls

Deep Dive

Video Credit: EMRAP

Brandon Simpson, PA-C
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