Skin/Soft Tissue

  • Hair Tourniquet Management
  • Subcutaneous Abscess I&D
  • Subungual Hematoma Evacuation
  • Suturing (General)
  • Tongue Laceration Repair

Hair Tourniquet Management

  • 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. 
Video Credit: Larry Mellick

*Deep Dive: Trick of the Trade: Hair Tourniquet Release (ALiEM)



Subcutaneous Abscess I&D

  • 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.
Video Credit: Core EM

*Deep Dive: Abscess Incision and Drainage (SAEM)



Subungual Hematoma

  • 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
Video Credit: EM:RAP

*Deep Dive: How to do Nail Trephination (Merck Manual)



Suturing (General)

  • 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
Video Credit: Dr. Zenn

*Deep Dive: Closing The Gap Blog



Tongue Laceration Repair

  • 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
Video Credit: EM:RAP

*Deep Dive: How to Repair a Lingual Laceration (EP Monthly)


Brandon Simpson, PA-C
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