Pediatric emergency medicine trisk 3367 3367

and frequently there is more devitalized tissue. Therefore, these wounds are more
likely to become infected and are often more difficult to repair. Finally,
compression injuries from blunt trauma perpendicular to the skin cause the most
tissue disruption and devitalization. These wounds are characterized by ragged
edges, and lead to the highest infection rates and risk of scarring.

Cosmesis and Wound Healing
Normal skin is under constant tension due to high collagen content. Tension is
also produced by underlying structures such as joints and muscles. The amount of
tension varies by anatomic location and position of a body part. Lacerations that
run parallel to joints and follow Langer lines of skin tension usually heal more
quickly and with better cosmetic results. Wounds under a large amount of tension,
crossing joints, or perpendicular to wrinkle lines may heal with wide, or more,
visible scars.
Lacerations regain about 5% of their previous strength 2 weeks after injury,
30% after 1 to 2 months, and full tensile strength 6 to 8 months after the original
injury. Many factors, such as infection, tissue edema, and poor nutrition, may
delay this progression.
All wounds deeper than the dermis have the potential for scar formation. Scar
formation involves the laying down of collagen, which is a complex process
essential in restoring tensile strength of the skin. Collagen synthesis begins within
48 hours of the injury and reaches a peak within the following week. Anything
that interferes with collagen synthesis, such as infection, may lead to wound
dehiscence at this time. Tissue contraction is expected with all healing wounds
through the action of fibroblasts. Therefore, eversion of suture lines is desired at
the time of repair so the skin will contract to become flat after healing.
Remodeling may occur for up to 12 months. The scar may fade and recede over
the first 3 months, and the final appearance of the scar may not be apparent until
6 to 9 months after injury.

Parental Satisfaction

In general, there are many factors that influence parental and patient satisfaction
with ED experience. In the case of lacerations, as in any pain-inducing condition,
parents are concerned that their child’s pain, both at presentation and during any
repair, is addressed properly. Additionally, parents are almost always concerned
about the cosmetic outcome of the wound, particularly in the case of facial
lacerations. Communicating information about the healing process, the nature of
the wound, and the expected cosmetic outcome, as well as the timeline for
complete healing can help prevent dissatisfaction.