Free BCEN Certified Emergency Nurse (CEN) Practice Question

For deep lacerations that expose subcutaneous fat but do not involve muscle or tendon damage, layered closure is typically the most appropriate initial management. This approach involves closing the deeper layers of tissue with absorbable sutures before closing the skin surface. Layered closure helps to reduce dead space, decrease tension on the wound edges, and promote better healing with less scarring. While simple interrupted sutures might be sufficient for more superficial lacerations, they may not provide adequate support for deeper wounds. Tissue adhesive (glue) is generally used for smaller, less deep lacerations. Staples, while quick to apply, are not typically the first choice for arm lacerations due to cosmetic concerns and potential for more pain. It's important to note that proper wound cleaning and assessment for foreign bodies should be performed before closure, and tetanus prophylaxis should be considered based on the patient's immunization status.