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Rate of Wound Infection After Repair
The rate of wound infection is reported between 2% and 10%. Decreasing the
likelihood of infection can help prevent additional morbidity and optimize
cosmesis, as wounds that are infected during the healing process are more likely
to scar. Efforts to reduce the risk of infection can be achieved by proper
techniques discussed throughout the chapter.

Current Evidence
Lacerations account for 30% to 40% of all injuries in a pediatric ED. Blunt
trauma with sufficient force or contact with sharp objects causes the majority of
lacerations. Animal bites account for the remainder. More than 40% of the
wounds involve a fall. Boys are injured twice as often as girls. The mechanism of
injury varies with the patient’s age. In younger children, falls and accidents are
classic mechanisms; violent encounters are more likely in older children.
Two-thirds of the injuries occur during warm weather months, although half of
injuries in urban environments occur indoors. Serious morbidity or mortality from
minor lacerations is rare; however, complications occur in nearly 10%. Children
are less likely to get wound infections compared with adults. In children, the
infection rate is about 2% for all sutured wounds. The risk of infection increases
if there is a delay in primary closure.
Absorbable sutures for the repair of facial lacerations in children can be used to
avoid the need for suture removal. Data support that these sutures have equally
acceptable cosmetic outcomes in facial lacerations.
In pediatrics, it is important to consider painless alternatives to sutures in some
cases. These include tape strips and tissue adhesives (i.e., skin glue). Tape strips
have the advantage of not leading to marks in the skin, minimal tissue reaction,
and fewer wound infections than sutures. Skin glue has been demonstrated in
multiple studies to have cosmetic results that are comparable to those of sutures
for low-tension wounds.
There are no proven benefits to the use of routine oral antibiotics to prevent
wound infection and their use is controversial. The risk of antibiotic use from

allergic reaction to growth of resistant organisms may outweigh the benefits.
Antibiotics should be routinely considered for wounds with high risk of infection
such as bites, devitalized tissue, and heavily contaminated wounds.
The immunization and tetanus status of a patient with a wound should always
be obtained and guidelines for tetanus prophylaxis followed, which is discussed
later in the chapter ( Table 110.1 ).

Clinical Considerations