Wound Care Answers 519(a)A complete eye examination should be performed to detect any
injuries to the lacrimal duct, supra and infraorbital nerves, or the globe. (b)
Tissue adhesives are contraindicated near the eye and other mucosal surfaces.
Even when using tissue adhesives to close non-periocular lacerations, extra
care should be taken to avoid runoffs into the eye. Positioning the patient
parallel to the ground, applying small amounts of tissue adhesive, and cir-
cumscribing the laceration with petroleum jelly will all prevent runoff into
mucosal surfaces. If eyes are exposed to tissue adhesives, irrigate thoroughly.
(d)Ptosis is not common following an eyelid laceration.(e)Lacerations to
the upper or lower eyelid medial to the punctum can involve the lacrimal
duct. Improper repair of the lacrimal duct can result in chronic tearing.
474.The answer is e.(Roberts and Hedges, pp 292-294). This patient has a
<10 mm dermal slice that is generally managed with bleeding control, non-
adherent dressing, and a finger splint to prevent reinjury and decrease
pain.Dressing changes have to be performed every 24 to 48 hours. Fingertip
amputation>10 mm, exposure of the bone, or involvement of the nail may
require a hand surgeon consultation. However, this patient’s dermal slice is
5 mm and does not involve the phalanx or nail, therefore, it can be managed
conservatively. Pressure dressing is typically sufficient to control bleeding
in dermal tip amputations. If hemostasis is not achieved with direct pressure,
commercial hemostatic agents can be used.
Management of fingertip amputations is controversial. For amputations
involving a significant amount of the distal digit various techniques, such
as partial-thickness skin grafts and full thickness skin grafts exist. Most of
these are performed in the operating room by a hand surgeon. (a, b, and d)
However, replantation of a <10 mm dermal tip is not indicated. Despite
replantation, the amputated tip is most likely to necrose and slough off.
Using the amputated piece as a natural dressing is unnecessary given the
small size of the wound. (c)Digital blocks are helpful for pain relief while
the patient irrigates the distal tip. Epinephrine is not recommended for use in
digits. The most appropriate way to achieve hemostasis is with direct pressure.