Which type of laceration typically requires operative repair?

• A. Closed lac
• B. Both
• C. Neither
• D. Open lac

Answer: (D)

Open lacerations are the ones that typically require operative repair because they involve full-thickness tissue disruption with exposure of deeper structures, potential tissue loss, and often contamination. In such wounds, simply approximating the skin from the outside isn’t enough; you need to debride nonviable tissue, assess and repair underlying structures (like tendons, nerves, vessels, or fascia), and close in a layered fashion to restore function and appearance. This is usually done in a controlled surgical setting to ensure proper alignment and healing.

Closed lacerations, by contrast, are generally superficial or have edges that approximate well enough to be closed in the emergency department with local anesthesia, adhesives, or simple suturing, without needing operative repair.