|To determine the best management for the child’s wound the following information should be considered:|
|Mechanism of Injury – will assist in determining the degree of devitalised tissue in the surrounding area|
|Shearing||sharp cuts, high velocity missiles|
|Tension||flap lacerations, avulsion injuries|
|Compression||direct blow causing both laceration and haematoma|
|Patient Factors – identify risk factors that may delay healing or cause infection / complications|
|General health||e.g. diabetes, malnutrition, shock, anaemia, renal failure, tendency to form keloid scars|
|Medication||e.g. steroids or immunosuppressive drugs|
|Tetanus status||Refer to Tetanus Prophylaxis|
|Environment – where the wound occurred will determine likely contamination|
|Age of wound|
|Assess wound||Extent of Wound||Size, shape, site, structure and sensation|
|Deeper structures||Tendons, nerves, bones – check distal function, check for fractures – X-Ray if indicated|
|Blood supply||Flaps may be dusky, be mindful of damage to end arteries|
|Contamination||Dirt, foreign bodies – may require X-Ray or Ultrasound|
|Tetanus prone wounds||Tetanus can follow apparently trivial, even unnoticed wounds. However, some wounds tend to favour the growth of tetanus organisms: refer to Tetanus Prophylaxis for information regarding tetanus prone wounds.|
|Wounds Requiring Surgical Referral|
|Signs of vascular injury or compromise|
|Wounds requiring exploration and possible repair of deeper structures|
|Extremely large wounds – e.g. face > 3cm laceration|
|Extensive repair in sensitive areas eg perineum, medial canthus eye|
|Highly contaminated wounds which require thorough debridement|
|Uncooperative patient unable to be adequately sedated by conscious sedation|
|Wounds requiring optimal cosmetic repair|
Requires exact approximation of the Vermillion border. May require plastics referral.
Tongue and Intraoral
May require referral to Ophthalmology, especially if fat exposed, deep involving muscles
or medial lacerations affecting tear duct structures – refer to Eye Trauma
Common injuries prone to infection. All require prophylactic antibiotics – refer to Antibiotics
Analgesia and sedation
Cleaning and irrigation
|Wound Repair Options|
|Wound tapes (Steristrips or Skinlinks)||
Suitable for simple linear lacerations with minimal tension.
Not useful on wet (oozing) areas or lacerations with surrounding abrasions.
Prepare intact adjacent skin with tincture of benzoin to aid adhesion, but avoid contaminating wound with it (causes severe pain).
|Tissue adhesive (e.g. Dermabond)||
Suitable for simple superficial lacerations (less than 3cm) especially on the face.
Avoid accidental spillage into the eye by careful positioning of patient and use of gauze. The applicator tip should never be pressed into the wound.
Suitable for clean uninfected wounds where the depth will lead to excess scarring if the edges are not properly opposed. Typically this is when the laceration extends through the dermis.
Absorbable (chromic) sutures are suitable for deep structures.
In general use interrupted sutures.
Suitable alternative for linear lacerations through the dermis that have straight edges on the scalp, trunk, arms and legs.
Can be more painful and cosmetically may cause more scarring. Can be placed more rapidly than sutures. Place staples approximately 0.5 – 1cm apart.
|Post Repair Wound Care|
|Dressings||Wounds and dressing guide|
|Antibiotics||Not a substitute for meticulous irrigation and debridement. If indicated initiate early.|
|Tetanus|| Ensure Tetanus prophylaxis +/‐ Ig for tetanus prone wounds in non immunised patients
refer to Tetanus prophylaxis
|Sun Exposure||Healing wounds are more sensitive to the sun. Sun protection maybe required for at least two years post injury.|
|Removal of sutures||3-5 days face, 7 days scalp, upper limb, anterior trunk, 10-14 days lower limb and back.|
|Removal of staples||1 week (provide staple remover to parents for LMO to remove)|
|Tissue adhesive||Remains for 1-2 weeks. Does not require removal.|
|Leukosan™ Skinlink™||Remain for up to 10 days. Does not require removal. If Skinlink™ begins to curl, the edges may be trimmed with scissors. Limited bathing. Always pat dry if exposed to moisture. Do not scrub.|
|Wound tapes||Do not remain in place for long periods. Keep dry for 24 hours. Limit bathing. Always pat dry if exposed to moisture.|
|Health fact sheet|
Help us provide guidelines that are useful to you, the clinician.Give feedback here