Pediatric emergency medicine trisk 3391 3391

Wound Care
Wound Dressing
Appropriate wound aftercare is important in preventing contamination or further
injury. It is recommended that most sutured wounds be covered with antibiotic
ointment and a dressing immediately after closure. For simple lacerations, an
adhesive bandage (e.g., Band-Aid) is sufficient, however larger wounds may
benefit from a nonadherent sterile dressing to prevent wound edges from sticking
to the dressing. This nonadherent dressing should then be covered with a layer of
gauze then tape. This technique helps to protect and immobilize the wound.
For the face and trunk, a large bulky dressing is not practical. Thus, for small
wounds in those areas, a clear plastic adhesive (e.g., Tegaderm) should be used to
secure the bandage. Rolls of cotton or stretchable tube gauze can be used to wrap
larger wounds to keep the sterile dressing in place. This keeps the young child
from touching the wound. Scalp wounds are usually not dressed, though gauze
and tube gauze may be applied prior to sleep to avoid staining linens with blood
or drainage. Patients can generally wash their hair gently after 24 hours.
For children who are active, it may be best to keep the wound covered until
sutures are removed. The original dressing should remain in place for 12 to 24
hours after which epithelialization is usually sufficient to keep the wound from
gross contamination. One study showed that uncovering after 12 hours with
gentle washing does not increase the risk of infection. After 12 to 24 hours, the
bandage should be changed daily and the wound inspected. Any dressing should
be changed sooner if it becomes soiled, wet, or saturated with drainage because
the wet dressing may become a source of infection.
It may be advisable to splint the wound if it overlies a joint. This is most
important for active children who will likely resume full activity soon after the
injury. Some even recommend splinting nearby joints for any large laceration of
an extremity to reduce stress across the wound even if it does not involve a joint
itself. This should be done for no more than 72 hours to prevent muscle atrophy
or joint immobility. The injured extremity should be elevated to provide comfort
and reduce edema.

Topical Antibiotics
For most simple wounds, it is adequate to cover the wound with dry sterile gauze
after applying topical antibacterial ointment. There have been several studies
looking at the different infection rates between certain topical antibiotics and
petroleum ointment. Overall, it has been found that a triple antibiotic ointment
may be preferable in preventing Staphylococcus aureus infection although there