Pediatric emergency medicine trisk 3373 3373

FIGURE 110.1 A seemingly superficial laceration at the wrist might be treated simply by
closure of the subcutaneous tissue and skin, unless one appreciates the abnormal posture of a
finger when the hand is at rest. The loss of normal flexor tone as a result of a divided superficial
tendon results in the involved finger lying in a position of relative extension.

Patients found to have vascular, nerve, or tendon injury or deep, extensive
wounds to the face warrant consultation with a surgical specialist for possible
repair in the operating room.
Management
Decision to Close the Wound. Most wounds may be closed primarily, meaning
the wound edges are approximated as soon as possible after the injury to speed
healing and improve the cosmetic result. If primary closure is delayed, the risk of
subsequent infection increases. Some authors suggest that the “golden period” for
wound closure is 6 hours. However, wounds at low risk for infection (e.g., a clean
kitchen knife injury) can be closed even 12 to 24 hours after the injury.
Most wounds of the face are best closed primarily, even up to 24 hours after
injury to achieve an optimal cosmetic effect. If the wound is extensive or has a
high potential for infection (e.g., a dog bite), thorough irrigation is essential, and
in cases of extensive or complex wounds, the operating room may be the best site
for this repair. Conversely, wounds at high risk for infection such as those in