Pediatric emergency medicine trisk 3366 3366

The Children’s Hospital of Philadelphia Clinical Pathway
Clinical Pathway for Evaluation/Treatment of Child With a
Laceration
URL: />Authors: S. Fesnak, MD; E. Friedlander, MD; E. Lichtman, RN
Posted: February 2019

GENERAL PRINCIPLES OF MINOR WOUND REPAIR
The goals of wound repair are to obtain hemostasis, prevent infection, minimize
pain, and achieve optimal cosmetic outcomes.

Obtaining Hemostasis
Hemostasis is important not only to prevent ongoing bleeding but also for clear
wound visualization prior to any repair. Application of direct pressure with gauze
is the fastest and most commonly used technique to obtain hemostasis. If there is
continued bleeding, applying a blood pressure cuff or tourniquet proximal to the
wound for a short period is acceptable. Injecting a local anesthetic with a
vasoconstrictor such as epinephrine can help with hemostasis and can be safely
used in areas of end-organ blood supply (e.g., digits, ear, nose, penis) despite
traditional warnings of caution.

Prevention of Infection
Bacteria inhabit normal intact skin. This is the usual source of infection when
skin tissue is disrupted. The amount of bacteria on the skin varies by anatomic
location. High counts of bacteria are in moist areas such as the axilla and
perineum, as well as in areas of exposed skin such as the hands, face, and feet.
Low counts of bacteria exist in dry areas such as the back, chest, and abdomen.
Areas colonized with high bacterial contamination are most prone to infection.
Wounds in regions of high vascularity, such as the scalp and face, are less prone
to bacterial infection despite the high bacteria count. The oral cavity is highly
contaminated with bacteria, and this is an important source of infection when a
child sustains a bite wound.

Wounds inflicted by shearing forces with a sharp object such as a knife cause
minimal devitalization of adjacent areas and thus are less likely to lead to
infection. Wounds caused by a blunt object striking the skin at an angle of less
than 90 degrees result in a tension injury such as an avulsion or flap. These
injuries involve a larger force applied to the skin than that of a shearing injury,