Skin laceration: is a generic term for open skin injuries, lump cuts, lacerations, and impact-induced skin dehiscence injuries. It is the most common trauma in the emergency department, and the prognosis is generally good if the treatment is standardized and timely. I. Detailed steps of debridement and suturing operation: 1. Clean the skin around the wound by covering the wound with sterile gauze, shave the hair around the wound, the range should be more than 5cm from the edge of the wound, and for those who have oil stains, wipe them off with gasoline or ether. 2, the surgeon wash hands, wear surgical gown after wearing sterile gloves, cover the wound with sterile gauze, brush the skin around the wound with soapy water and sterile brush, followed by sterile saline rinse, generally repeatedly rinse 3 times, seriously contaminated wounds can be brushed several times until clean, pay attention not to make the rinse soapy water flowing into the wound. 3, cleaning, checking the wound: the operator does not take off sterile gloves, remove the sterile gauze covering the wound, rinse the wound with sterile saline, and gently wipe the tissue inside the wound with the sponge clamp holding small gauze, rinse with 3% hydrogen peroxide solution, and then rinse clean with sterile saline after the trauma surface shows foam. Dry the rinsing solution in the wound and the skin around the wound, check the wound for blood clots and foreign bodies, and check the depth of the wound and whether there are combined nerve, blood vessel, tendon and bone injuries. If there is a lot of bleeding on the wound surface of the extremities, a tourniquet is available and the time of the tourniquet is recorded, at this time, the wound is covered with sterile gauze. 4, skin disinfection, laying sterile towels after hand washing and hand soaking without sterile gloves, disinfect the skin with 0.75% tincture of iodine, and lay sterile towels. Attention. Do not make the disinfection solution into the wound, local anesthesia around the wound if necessary. 5, clean up the wound operator, assistant again after disinfection of hands, wearing sterile gloves, with surgical scissors to remove the wound around the untidy skin edge l a 2mm, loss of vitality is gray or not bleeding purple skin should be removed. If the incision is too small, the incision should be expanded to fully expose. Generally, the incision should be extended along the longitudinal axis from both ends of the wound (sometimes the direction of the extended incision should be chosen according to the function and appearance), and the deep fascia should be cut accordingly to stop the bleeding completely. Special attention should be paid to the wounds near the hands, face and joints. Fatty tissue is prone to necrosis, liquefaction and infection, and inactive fascia will affect the wound healing, which should be removed as much as possible. 6, remove necrosis and loss of vitality of muscle tissue where the pinch does not contract, cut without bleeding or no color change of muscle tissue, should be completely removed or cut out. Contamination of small fragments of bone that are clearly separated from the periosteum can be removed, and larger pieces of free bone or small pieces of bone connected with soft tissue should be retained and put back in place to restore anatomical form and function, and small pieces of free bone within the joint capsule must be completely removed and the joint capsule sutured. 7.The treatment of vascular injury does not affect the wound blood circulation of the broken blood vessels, can be ligated. If the main blood vessel is injured, arterial and venous anastomosis or repair is required after clearing the planes. The proximal and distal ends of the injured vessels are stripped clearly, and the blood flow is blocked by clamping both ends with non-injury vascular forceps, removing one end of the vascular epithelium with small scissors, and trimming the broken end neatly and then pairing the two broken ends. A mattress suture is made on each side with a fine silk thread, and the lumen is flushed with saline with a little heparin to prevent re-clotting of the clot. The two sutures are held tight, and the anterior wall is sutured with continuous sutures, and the posterior wall is sutured by flipping the vessel according to the anterior method. Relax the distal vascular clamp, check whether the anastomosis is tight, if there is no gap, that is, remove the proximal vascular clamp and restore blood flow. 8. Suture the wound following the principle of clean suture to complete the wound that meets the suture requirements, and the wound treated by the above steps is a clean wound, and then rinse the wound with sterile saline. If the sterile towel on the operating table has been soaked through, it should be covered with a sterile towel. The wound is cleaned and sutured from deep to superficial layers according to the local anatomical level. Avoid leaving an invalid cavity to prevent the formation of a hematoma, and suture with appropriate tightness to avoid affecting local blood flow. After suturing the subcutaneous tissue with interrupted sutures, the skin around the wound is disinfected with 70% ethanol and the skin is sutured with interrupted sutures. Align the skin edge, squeeze out the subcutaneous blood, disinfect the skin again with 70% ethanol, cover with sterile gauze, and properly dress and fix. 9.When the wound is superficial, with good hemostasis and no invalid cavity after suturing, it is generally not necessary to place drainage. Deep wounds, large and heavy damage range. When the wound with heavy contamination and invalid cavity may exist with hematoma formation, drainage should be placed. II. Postoperative related precautions 1. For larger and deeper wounds, tetanus injection should be given within 24 hours after surgery. 2. Avoid smoking, alcohol and spicy diet for 1~3 months after surgery, in order to avoid stimulating scar growth; dark foods such as soy sauce can be consumed normally and will not cause the wound color to darken. 3.Avoid sun exposure for at least 3 months to prevent pigmentation. 4.For perioral and cheek wounds, do not consume overly hot or hard food before stitch removal. For intraoral wounds, rinse mouth with mouthwash at least three times a day. 5.Postoperative suture removal and medication change time: the wound needs to be kept clean and dry, and the suture removal and medication change time is detailed in the suture removal and medication change sheet given to you. In general, the wound needs to be changed 1-2 times before the removal of stitches, 4-5 days for the face and neck; 1 week for the head; 10-12 days for the extremities; 2 weeks for the hands and feet; 7-9 days for the upper abdomen, chest, back and buttocks. The specific stitching time needs to be combined with the condition and the patient’s age and other factors for comprehensive consideration. 6.If the wound is deep and large or heavily contaminated, oral or intravenous antibiotics can be applied to prevent wound infection as prescribed by the doctor. 7. If the patient is a child or a young woman, topical medications such as scar removal, Bevoxin or Conrad can be applied appropriately to prevent excessive formation of scar tissue.