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Appearing unhurried and confident, giving the child, when age
appropriate, some control of the situation, and explaining the upcoming
procedure can help reduce anxiety.
Use of distraction techniques and anxiolytics can avoid the need for
procedural sedation.
Tap water can be used instead of saline and is equally effective in
reducing the risk of infection.
Using 6-0 absorbable material is recommended for skin closure
whenever possible and obviates the need for suture removal at followup.
No specific ointments or creams have been found to be helpful in scar
reduction. However, application of sunscreen after the wound heals
may decrease hyperpigmentation of the forming scar.
The use of epinephrine with local anesthesia during lip laceration repair
could obscure the vermilion border landmark.
The eyebrow should not be shaved during wound preparation as
regrowth is unpredictable.
If the frontalis muscle is involved and is not properly approximated, its
function (eyebrow elevation) could be disrupted.
In repairing the earlobe or auricular rim, if the skin edges are not
everted at the time of closure, “notching” may occur.

Forehead Lacerations
Forehead lacerations are common in early childhood. These injuries commonly
occur after falls on objects or furniture such as coffee tables. Most of these
lacerations are simple and not associated with any other significant injuries.
However, careful evaluation of the head and neck for other injuries is warranted.
Superficial transverse lacerations of the forehead usually have a favorable
cosmetic outcome. Closure with simple or continuous cuticular sutures using 6-0
absorbable material is recommended. Deeper transverse lacerations involving the
deep fascia, frontalis muscle, or periosteum should be repaired in layers.
Absorbable 5-0 material such as Monocryl, coated Vicryl, or gut can be used. If

the deeper tissue plains are not closed, the function of the frontalis muscle, that is,
eyebrow elevation, may be hampered. Other facial expressions can also be
affected because the skin may tether to the scar tissue, bridging the unrepaired
gaping tissues.