Written By: Dr. Jassin Jouria
A 23-year-old female is brought to the Emergency Room after accidentally cutting her fingers with a box cutter while opening a box at work. She states that she asked her employer for a sharper razor since she has been having to put a lot more force into cutting open the boxes lately, but her boss said to keep using the same blade for now. The patient says this caused her to slip her hand position and cut her thumb and index fingers. She complains of sharp pain and a lot of bleeding. The Emergency Room physician immediately orders an X-ray to evaluate for any foreign objects and prepares a laceration repair kit to close the bleeding wounds.
A laceration injury is one where a sharp instrument, typically a blade or knife, penetrates through the skin causing a tear or gashing wound. They are blunt force injuries in which the sheer force tears apart the skin and underlying tissue. Laceration injuries are one of the most common types of injuries to occur at the workplace. Though usually of a minor type, they can sometimes be fatal too.
Laceration Injuries at Workplace-Some Statistics
The Occupational Safety and Health Association (OSHA) published some numbers and statistics regarding laceration injuries at the workplace. According to OSHA, the total injuries reported were 916,440 while nearly eight percent of those, or 71,100 were lacerations. This makes cuts and lacerations approximately 30% of all occupational injuries. Almost 70% of cuts and lacerations involve the hands and fingers.
At-Risk Occupations for Laceration Injuries
Even though the risk of cuts and lacerations is present in almost every occupation, it is significantly high in some particular ones. The most at-risk occupations include:
- Welding Industry
- Construction Industry
- Ceramics Industry
- Woodwork Industry
- Food Handling Industry
- Steel and Iron Industry
- Heavy Machinery Industry
The Risk of Laceration Injuries at Work
Several occupations involve sharp machinery, knives, or blades handling. This puts the workers at a considerably higher risk of laceration injuries. The severity of a laceration injury is spread over a wide spectrum. At the low-risk end of the spectrum lies minor tissue injury with minimal damage. The most severe lacerations include full-thickness injuries. This type involves extension into the subcutaneous tissue which can be an underlying muscle, bone, or organ.
The most serious and fatal complications of a laceration in the workplace are sepsis and significant blood loss.
What does the Law say about Laceration Injuries at Workplace?
Being the second most common type of injury at the workplace, OSHA has set some laws about laceration injuries. OSHA ensures the safety and compensation of workers who have been lacerated at the workplace.
Since a laceration injury may require extensive medical treatment or sometimes even long-term rehabilitation, workers are liable to compensation. Any person who has been injured by a cut or laceration can file a complaint. The State Worker’s Compensation covers work-related laceration injuries. In such a case, the worker, after filing a complaint, might be compensated for medical bills and lost wages.
Therefore, workers need to know their rights and privileges in their respective occupations.
Types of Laceration Injuries at Workplace
Cuts and lacerations in the workplace can be majorly classified into the following different types:
- Chop Lacerations
This type is often seen in cases of injury by a heavy, bladed-edged instrument such as an ax, machete, meat cleaver (chopper), spades, or hatchets.
A chop laceration can be recognized by heavy bruising and abrasions around the margins of the wound.
Chop lacerations usually cause significant bleeding. It leaves a gaping wound that can often cause the amputation of a limb. It is one of the most severe types of lacerations leading to fatality.
Management of Chop Lacerations
- Wear protective gear while working near choppers or with axes.
- In case of a chop laceration, try to control the bleeding.
- To prevent the risk of infection, perform debridement of the wound site.
- Immediately shift the patient to emergency care.
Timely management is extremely important in reducing the morbidity and mortality of a chop laceration.
- Avulsions
This type of injury is often called a de-gloving injury. This is because an avulsion is the separation of the skin from the underlying structures as a result of sheer force. It is a serious and extensive laceration involving a deep break to the skin and underlying tissues. It is often seen in heavy machinery injuries.
Management of Avulsions
- Preventive measures should be fully undertaken to avoid such an accident.
- In case an avulsion occurs, the foremost step should be to determine the extent of the wound.
- Since there is a high risk of sepsis (infection), the wound area should be carefully decontaminated.
- All pieces of dirt and debris should be removed adequately before shifting to an emergency center.
- Control bleeding from the site by elevation or pressure mechanisms.
- If the avulsion is incomplete, cover the wound site with the skin flap.
- If the avulsion is complete, bring the avulsed tissue along with the patient to the medical center.
Timely management of an avulsion is necessary to prevent lifelong disability.
- Split Lacerations
Most of the lacerations on the scalp, face hands, or lower legs are of this type. It usually occurs as a result of a perpendicular impact. The skin and subcutaneous tissue are crushed between two hard objects causing a split in the skin.
It is mostly caused by trauma from sharp, heavy objects.
Management of Split Lacerations
- Wear protective gear at all times.
- In case of a split laceration, determine the extent of the wound.
- Try to stop the bleeding by pressure or elevation.
- Debride the wound site from contaminants, dirt, and debris.
- Immediately shift the patient to the emergency.
Meet the Author Dr. Jassin Jouria
Dr. Jassin Jouria is a practicing Emergency Medicine Physician who specializes in resuscitation of critical patients. The majority of his clinical work is at the Decatur County Memorial Hospital Emergency Department in Greensburg, Indiana. Learn More About the Author.
References:
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- https://www.omeda.org/safety/safetyvault/SMNS_Cuts%20and%20Lacerations.htm
- https://www.britannica.com/science/laceration
- https://pubmed.ncbi.nlm.nih.gov/24800900/
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