Pediatric emergency medicine trisk 3304 3304
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Anesthesia, copious irrigation, and tension-free approximation are vital to a
successful closure. Subspecialty consultation may be warranted for latepresentation lacerations or heavily contaminated wounds, in which the risk of
infection is high.
If possible, facial lacerations should be repaired using buried absorbable
sutures, to reduce tension on the wound and to help with eversion of the edges.
All wounds contract as scar formation occurs and thus eversion of the skin should
be achieved for facial lacerations, particularly those involving the nares, eyelids,
helix of the ear, and vermilion border of the lower lip. Inadequate eversion of the
wound edges at these sites may lead to a depressed scar or notching at the site of
the laceration. For simple scalp lacerations, stapling is a fast and cosmetically
acceptable alternative to suturing.
Repair of complex injuries to laminated structures (e.g., ear, eyelid, nose, lip)
requires that each layer of the structure be reapproximated. For example, a fullthickness laceration to the nose at the nostril rim requires closure of three separate
layers. The nasal lining is usually closed first with an absorbable suture material.
Next, the cartilage must be repaired, also with absorbable material. Finally, the
overlying skin of the nose can be reapproximated. Similarly, complex injuries of
the ear, the eyelid, or the lip require layered closure to achieve the best cosmetic
result. Careful attention should be paid to lip lacerations that traverse the
vermilion border. Cosmetic outcome is predicated on successful alignment of
tissue at this junction. Subspecialty consultation may be considered for
lacerations involving the external ear, nasal mucosa and cartilage, as well as
complex lip lacerations traversing the vermilion border.
Informed consent should be obtained from patients and families undergoing
laceration repair, and this information should be documented in the medical
record. The physician should provide a careful assessment and natural history of
the injury if left untreated to heal on its own. The physician should also describe
the recommended treatment, as well as alternative treatments, with likely
outcomes and possible complications. Patients with lacerations resulting from dog
bites and those who present for care after a delayed period of time should be
advised of the high risk of infection. Complicated facial laceration repair and
laceration repair in young children may be facilitated by the use of a short-acting
benzodiazepine or procedural sedation.
Current Evidence
Randomized controlled trials that compared fast-absorbable plain catgut to
nonabsorbable nylon sutures have demonstrated no significant difference in short-
