| ICD-9-CM: |
| 870.0 - | Laceration of Skin of Eyelid |
| 870.1 - | Laceration of Eyelid, Full-thickness, Not Involving Lacrimal Passages |
| 870.2 - | Laceration of Eyelid Involving Lacrimal Passages |
| 871.0 - | Ocular Laceration without Prolapse of Intraocular Tissue |
| 871.1 - | Ocular Laceration with Prolapse or Exposure of Intraocular Tissue |
| 871.4 - | Laceration of Eye, Unspecified |
| 872.0 - | Open Wound, External Ear, without Mention of Complications |
| 873.0 - | Open Wound, Scalp, without Mention of Complication |
| 873.20 - | Open Wound, Nose, Unspecified Site, without Mention of Complication |
| 873.40 - | Open Wound, Face, Unspecified Site, without Mention of Complication |
| 873.41 - | Open Wound, Cheek, without Mention of Complication |
| 873.42 - | Open Wound, Forehead, without Mention of Complication |
| 873.43 - | Open Wound, Lip, without Mention of Complication |
| 873.44 - | Open Wound of Jaw, without Mention of Complication |
| 873.49 - | Open Wound, Face, Other and Multiple Sites, without Mention of Complications |
| 873.60 - | Open Wound, Mouth, without Mention of Complications, Unspecified Site |
| 873.8 - | Open Wound, Other and Unspecified Open Wound of Head without Mention of Complication |
| 874 - | Larynx and Trachea, without Mention of Complication |
| 875.0 - | Open Wound, Chest without Mention of Complication |
| 876.0 - | Open Wound, Back without Mention of Complication |
| 877.0 - | Open Wound, Buttock, without Mention of Complication |
| 878 - | Open Wound, Genital Organs (External), Including Traumatic Amputation |
| 879 - | Open Wound, Other and Unspecified Sites, Except Limbs |
| 879.0 - | Open Wound, Breast, without Mention of Complication |
| 879.6 - | Open Wound, Other and Unspecified Parts of Trunk, without Mention of Complication |
| 879.8 - | Open Wound, Multiple Unspecified Sites, without Mention of Complication |
| 880.0 - | Open Wound, Shoulder and Upper Arm, without Mention of Complication |
| 881.0 - | Open Wound, Elbow, Forearm, and Wrist, without Mention of Complication |
| 882.0 - | Open Wound, Hand, Except Finger(s) Alone, without Mention of Complication |
| 883.0 - | Open Wound, Finger(s), without Mention of Complication |
| 884.0 - | Open Wound of Upper Limb, Multiple and Unspecified, without Mention of Complication |
| 890.0 - | Open Wound of Hip and Thigh, without Mention of Complication |
| 891.0 - | Open Wound of Knee, Leg [except Thigh], and Ankle, without Mention of Complication |
| 892.0 - | Open Wound, Foot except Toe(s) Alone, without Mention of Complication |
| 893.0 - | Open Wound of Toe(s) including Toenail, without Mention of Complication |
| 894.0 - | Open Wound of Lower Limb, Multiple and Unspecified, without Mention of Complication |
| A laceration is a cut that results in a jagged wound in the skin. Lacerations can be shallow cuts or deep gashes that penetrate through muscle to internal organs and bone. A superficial laceration involves only the skin, and because there is no penetration of major blood vessels, bleeding will probably stop with pressure within a few minutes. A deeper laceration may penetrate veins or arteries, and in some cases, the blood vessel may require repair. Causes of lacerations include accidents at home and work, motor vehicle crashes, and violence. Risk: Individuals who work with sharp instruments and objects, especially workers in the food industry, are at risk for lacerations. Lacerations are the most common nonfatal injury in the 10- to 17-year age group (Rubin). Incidence and Prevalence: About 11 million cases of lacerations are reported annually in the US (Rubin). |
Source: Medical Disability Advisor
| History: A careful history will establish how the accident occurred, whether other injuries were overlooked in the initial assessment, and whether the individual has any underlying medical conditions or takes any medications that could affect recovery.
Individual reports recent injury or trauma involving a sharp object or objects. The sharp object can be anything from paper edges and broken glass to knives, opened cans, scissors, nails, farming tools, or building materials. Physical exam: A thorough physical exam will include vital signs (blood pressure, heart rate, temperature, respiratory rate, all of which can indicate shock), assessment of the degree of injury, and a thorough search for any additional injuries. The exam may reveal a bleeding wound. The skin around the wound may be red, warm, and tender. The condition of the skin, nerves, tendons, blood vessels, bones, cartilage, muscles, and fascia of the involved area should be examined for damage. Tests: X-rays, CT, and MRI may be needed if deep lacerations have occurred since these imaging modalities can show foreign bodies as well as muscle and tendon damage and broken bones. |
Source: Medical Disability Advisor
| A superficial laceration is thoroughly washed with sterile solution, and bleeding is stopped. The edges of the wound may be held together with steri-strips, butterfly bandages, or tissue glue to hasten healing. Then the wound is covered with antibiotic ointment and bandaged. A tetanus booster may be given if 7 to 10 years have passed since the individual’s last tetanus immunization. For individuals who have never been immunized against tetanus, immune globulin is given, and the tetanus immunization series is started. If the laceration involves exposure to human blood or bodily fluids, the individual may be started on the immunization series for hepatitis B.
A deeper skin laceration is treated with stitches (sutures) or staples after the individual is given local anesthesia through topical application or injection. General anesthesia may be needed to surgically repair deep lacerations involving muscle, tendon, blood vessels, and internal organs. A deep laceration involving internal organs and massive bleeding is treated as a surgical emergency to prevent the individual from going into shock or bleeding to death. |
Source: Medical Disability Advisor
| The individual with minor superficial lacerations should be completely healed within 2 weeks. Deeper lacerations or those in areas where the skin moves regularly, such as over and around joints, will take longer to heal. The individual with lacerations involving a severed tendon may regain only partial use of the muscle. If profuse bleeding from internal organs and blood vessels resulted from lacerations, the individual may suffer from severe blood loss that could delay recovery and could possibly result in death before, during, or after emergency surgery to repair the wounds. |
Source: Medical Disability Advisor
| Superficial lacerations do not require rehabilitation. However, rehabilitation following deep or significant lacerations becomes important when muscles, tendons, and other joint-related structures are involved. In these cases, loss of motion to the involved joint becomes a concern because of scar tissue formation and damage to the muscle-tendon unit. The early stages of rehabilitation begin with controlling pain and swelling, preventing infection, and minimizing any loss of function.
Cold treatments (cryotherapy) after laceration help to control swelling of soft tissues. This is accomplished using cold packs with or without compression.
Once pain and swelling have subsided, rehabilitation focuses on returning range of motion to the affected joints and strength to the muscles at or near the laceration. During the early stages of healing, therapy uses passive techniques to regain range of motion around the injured area. Later this progresses to active range of motion exercises. The goal is to help the individual return to normal functioning as quickly as possible.
Strengthening of the affected limb begins early in rehabilitation. In the case of lower extremity lacerations, walking exercise (gait training) may be indicated. Such exercises help the individual regain the ability to perform activities of daily living (ADLs).
The final step is to incorporate activities that will help the individual return to his or her previous work environment. They include exercises that resemble work requirements, along with individualized education to avoid recurrent injury. Modifications may need to be made by the physical therapist for those individuals who have experienced traumatic lacerations. Variations in rehabilitation will depend on the location of the laceration and whether surgery was required. |
Source: Medical Disability Advisor
| The individual may be more seriously injured than reported in the initial assessment; there may be internal bleeding or other internal injuries in addition to superficial lacerations. Bacteria, viruses, or foreign bodies may contaminate the wound, causing infection, disease, or delayed healing. Individuals may become infected with the HIV virus after being lacerated with an object that carries a significant amount of blood from an individual infected with HIV. |
Source: Medical Disability Advisor
| The individual with superficial lacerations can return to work immediately, provided that the severity and location of the laceration does not interfere with work. An individual with more serious injuries, such as damage to the muscle-tendon unit or internal injuries, may require specific accommodation or may not be able to return to work until substantial healing has occurred. |
Source: Medical Disability Advisor
| If an individual fails to recover within the expected maximum duration period, the reader may wish to consider the following questions to better understand the specifics of an individual's medical case. Regarding diagnosis:
- Did the individual sustain a laceration?
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Was the injury associated with significant bleeding or damage to underlying structures, such as muscles, tendons, or organs?
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Is the skin around the wound red, warm, and tender?
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If the laceration was deep, were x-rays, CT scans, or MRI obtained?
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Was individual evaluated thoroughly and promptly following the traumatic event?
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Was the full extent of the injury determined within 24 hours?
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Were there any additional injuries?
Regarding treatment:
- How severe was the laceration, and how promptly was medical care obtained?
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Were minor or superficial lacerations treated with thorough cleansing of the wound, application of an antibiotic ointment, and bandaging?
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If the laceration was deep, were tendons, blood vessels, or organs disrupted?
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Was there a significant loss of blood?
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Was surgery required to repair the structures that were damaged by the laceration?
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Were there any postsurgical complications?
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Did the individual receive tetanus and hepatitis vaccines as needed?
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Were antibiotics prescribed for contaminated wounds or those with signs of developing infection?
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Was individual compliant with the antibiotic regimen?
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Did individual require physical or occupational therapy?
Regarding prognosis:
- Was the laceration superficial or deep?
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Is it located over or around a joint?
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Does individual have any underlying conditions that could prolong recovery, such as diabetes, a bleeding disorder, or a depressed immune system?
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Was there associated tendon, organ, or blood vessel damage?
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If so, is the damage temporary or permanent?
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Did individual follow any recommended occupational or physical therapy guidelines?
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If not, are there barriers, such as insurance limitations, lack of motivation, or transportation problems, that may be preventing the individual from participating in the rehabilitation treatment?
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Did individual experience any complications that would affect prognosis?
|
Source: Medical Disability Advisor
| "Cuts, Scrapes, and Stitches: Caring for Wounds." familydoctor.org. Dec. 2006. American Academy of Family Physicians (AAFP). 22 Dec. 2008 <http://familydoctor.org/online/famdocen/home/healthy.html>.Eidelman, A., et al. "Topical Anaesthetics for Repair of Dermal Lacerations." Cochrane Database of Systematic Reviews 3 (2005): Farion, K. J., et al. "Tissues Adhesives for Traumatic Lacerations in Children and Adults." Cochrane Database of Systematic Reviews 4 (2001): Rubin, Aaron. "Managing Abrasions and Lacerations." Physician and Sports Medicine 26 5 (1998): 45-55. |
Source: Medical Disability Advisor
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