Paediatric Acute care Guidelines PMH Emergency Department

Background

Indications
  • Simple clean superficial lacerations (less than 3 cm) 
  • Good wound approximation 
  • Low wound tension
Contraindications
  • Jagged lacerations
  • Bites, punctures or crush wounds
  • Contaminated wounds
  • Mucosal surface
  • Axillae and perineum (high moisture areas) 
  • Hands, feet and joints (unless kept dry and immobilised) 
Properties
  • Maximum bonding strength is at 3 minutes
  • Can be applied without anaesthetic 
  • Water resistant 
  • The glue will slough off within 5-10 days
  • Equivalent cosmetic result to sutures

Procedure

Assistance with the procedure will generally be required, especially with an active child (4 hands are better than 2) 

  • Apply topical anaesthetic (as required)
  • Irrigate with 0.9% saline
  • Appose wound edges
  • Crush Dermabond®  vial and invert
  • Gently brush adhesive over laceration
    • Do not place glue into the wound – this will impair wound healing and lead to wound dehiscence

  • Wait 30 seconds
  • Apply second layer in an oval motion around the wound – coverage of a larger skin surface area adds to strength of wound closure
  • Apply a third layer after a further 30 seconds
  • No dressing is required but in small children a dressing may be required to prevent picking of the glue 
Lacerations near the eye
Methods to prevent glue entering the eye:
  • Lower the head end of the bed
  • Apply Vaseline below the wound
  • Hold saline soaked gauze over the eye
  • Ensure the child is compliant or well held 

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