Pediatric emergency medicine trisk 3394 3394

TABLE 110.4
DISCHARGE INSTRUCTIONS FOR WOUND CARE
1. Keep the wound clean and as dry as possible for the first 24 hrs. The skin
around the wound may be cleaned gently.
2. After 24 hrs, the child may shower and dry the wound gently and completely.
3. Avoid any activities that will keep the wound soaked in water (e.g.,
swimming and a bath) until sutures are removed.
4. Consider oral pain medications.
5. Provide instructions for topical or oral antibiotics if they are recommended
for the patient.
6. If a splint is applied, it should be kept on, clean and dry.
7. Sunscreen may be applied after the wound heals, to minimize pigment
changes.
8. Watch for signs of wound infection and dehiscence.
9. Arrange follow-up for recheck as needed.
Most wounds can be followed up at the time of suture removal. Those wounds
requiring close follow-up (at 24 to 48 hours) include those that are contaminated,
those with tenuous vascular supply, and those showing any signs of infection.
Wounds closed with tape strips do not require removal of the tape because these
will fall off spontaneously. The family should be instructed to trim any edge of
adhesive tape as it lifts off the skin, but not pull the strips off. Tissue adhesive
also sloughs spontaneously. However, nonabsorbable sutures should be removed
at the appropriate time, depending on the location of the injury. The importance
of timely removal should be stressed to the patient and family. Removing sutures
too early may lead to dehiscence and widening of the scar. Sutures left in too long
may create an unnecessary tissue reaction and result in visible cross-hatching
(“railroad ties”).
Wounds on the scalp or face are nourished by a better blood supply and
generally exhibit more rapid healing. Sutures in these areas are removed more
quickly than other locations to avoid unsightly tracts.
When sutures are subject to considerable tension (over joints and on the

hands), they should be left in place longer ( Table 110.5 ). After removal of
sutures, it may be necessary to reinforce the healing wound with tape strips to
prevent dehiscence.