Lacerations and Other Wounds
Injuries are something we see often in children. Ranging from minor scrapes and bruises to more serious trauma. When children get a cut, the most common question is, does the wound need to be closed? Here at Holland Pediatrics, we are always happy to help you make that decision. However, if you are the type of parent that prefers to try to make these decisions on your own, I wanted to provide you with some helpful information.
How are wounds closed?
- Skin glue. This can be used on some lacerations that are not under tension and not over a joint. Does not work well on large lacerations. Not as strong as stitches so more prone to re-opening. Must be kept dry. Dissolvable.
- Staples. Typically used to close cuts on the scalp in the hair. Need to be removed.
- Steri-strips. Best for cuts that are not deep. Apply a bit of tension to keep the wound closed. Cannot be used on high tension wounds or those over a joint. Need to be left on for at least 3 days.
- Sutures (stitches). Provide more strength and holds wounds together well. Need to be removed unless absorbable sutures are used.
Here are factors that we take into account when deciding if wound closure is necessary:
Can you control the bleeding? If you cannot control the bleeding after holding pressure on the wound for 30 minutes or if you are able to control the bleeding but then it easily starts bleeding again, your child may need wound closure.
Do the edges of the wound gap open? If the edges of the wound do not stay together on their own, your child may need wound closure.
How long and deep is the laceration? If the laceration is ¼ inch or deeper and a ½ inch or longer, your child may need wound closure. Some lacerations may need wound closure even if they are less than a ½ inch long. For example, lacerations of the face should be evaluated if they are ¼ inch or longer. Deep puncture wounds should be evaluated for wound closure even if they are less than ½ inch long.
Is there any concern for a foreign body? If the wound occurred from something like a stick or glass that may have broken off in the wound, you should have the wound checked for foreign body and possible wound closure after removal.
How long has it been since the injury? It is best to get the laceration evaluated and closed as soon as you can after the injury. If it has been more than 8 hours since the injury the risk of infection increases and therefore depending on the location of the laceration, the provider may choose not to close it. However, if you are not able to get to a location where the wound can be closed within 8 hours, it is still good to have the wound evaluated if you think it may need closure because some wounds can be closed up to 24 hours later. If you do decide to wait or are unable to have your child seen within 8 hours you should wash your child’s cut under the faucet to get out any dirt. Do not let the cut dry out. Wet some gauze pads and tape them over the cut. Change the gauze every two hours to keep it moist. If your child’s wound is closed after 8 hours, there may be extra measures taken to help prevent infection. If wound closure is not done, your provider may provide you with extra instructions on how to care for the wound best in order to minimize infection and help it heal well.
Is the laceration over a joint or the shin? Lacerations over a joint are likely to need sutures. These lacerations are more likely to gape open with movement of the joint. This causes increased tension on the wound edges making it less likely to heal nicely without sutures. The skin over our shins is also under a lot of tension and therefore these wounds are also more likely to gape open and require sutures.
Other important things to consider:
Is your child’s Tetanus shot up to date? If it has been 5 years since your child’s last Tetanus vaccine and they have a laceration or puncture wound, they may need another one.
Is the wound dirty? Even if the laceration does not require wound closure, your child’s wound may need to be evaluated and appropriately cleaned and cared for by a healthcare provider if it is dirty.
What if my child got stitches/staples but one of them came out and now the laceration is gaping open again? If it has been less than 48 hours since the laceration was closed call your healthcare provider as they may need to re-suture/staple or glue the open portion of the laceration. If it has been more than 48 hours, you should still call your healthcare provider to have the wound evaluated and if appropriate they may use skin tape to hold the portion of the laceration together that has re-opened. If a face wound re-opens call your healthcare provider immediately. It may need to be re-sutured or glued even if it has been more than 48 hours.
If you feel that your child needs wound closure or you would like to have their laceration evaluated, give Holland Pediatrics a call. Many of our providers are able to close wounds right in our office!
So, your child has had sutures or staples. Here are a few things your need to know:
How do I care for the wound? Wounds should be covered with a bandaid for the first 24 hours. During this time period it is normal for lacerations to continue to have some bleeding and drainage. If the wound was dirty, your healthcare provider may recommend application of an antibiotic ointment (such as triple antibiotic) twice daily to prevent infection and assist in wound healing. If the wound was not dirty, application of Vaseline twice daily can assist in wound healing and help to minimize scaring. Sutured wounds can be gently cleansed with a mild soap and water, once daily, 24 hours after the sutures were placed. This is also when the child can begin bathing again. Due to the increased risk of infection, it is best to avoid soaking the sutured/stapled area in water. Your child may not swim in lakes or ponds while they have sutures/staples in place, due to the increased risk of infection. Swimming in pools is also not recommended because prolonged soaking can weaken sutures, making them more likely to break.
How do I know if the laceration is infected? If there is increased redness or swelling around the wound, the wound has become more painful, or there is increased drainage from the wound, it should be evaluated for infection by your healthcare provider as soon as possible. Infections in sutured wounds need to be treated quickly as they can increase scarring.
How long do sutures/staples need to stay in?
- Face – 5 days
- Eyelids – 5 days (3 days for low-tension wounds and up to 7 days for high-tension wounds)
- Neck – 5 days
- Scalp – 7 to 10 days
- Trunk and upper extremities – 7 days
- Lower extremities – 8 to 10 days
- Digits, palm, and sole – 10 to 14 days
Your healthcare provider will tell you exactly when your child’s sutures/staples need to be removed when they are placed. It is important to get the sutures/staples removed on time as delaying it may increase scarring and may make sutures more difficult to remove.
After your sutures are removed there are a few things you can do to help with scaring. Once the wound has healed, apply an ointment like Vaseline, once daily, and using medium pressure massage the wound in a circular motion. This increases blood flow to the area which helps with healing. Limiting sun exposure is also important. Do your best to keep the wound covered or apply a high SPF sunscreen to the healed wound. This should be done anytime you are outside. Keep in mind that the appearance of scars changes with time. Scars are initially pink and puffy and may take up to a year before you see the final appearance of your scar. The final appearance of scarring depends on different factors like how well it is cared for, age, ethnicity, genetics, and the laceration size.