Minor lacerations are extremely common in childhood, and there
are a variety of different methods of management available. It is
important when active treatment is required that this is undertaken
in a way which allows the best functional and cosmetic result, with
the least distress to the child. The worst surgical results are
achieved in children who are "uncooperative" or terrified. All
children with lacerations should be fasted from arrival.
Before embarking on treatment in a child, consider whether you
have the necessary resources for optimum surgical result and
experience for the child eg. sedation, analgesia, anaesthesia,
appropriate experience, time & instruments, assistance (medical
and nursing). If in any doubt discuss with Emergency Registrar or
Consultant. Plastic surgical consultation may be advisable.
Adequate anaesthesia is necessary for complete examination,
cleansing and repair of wounds.
Can be cleansed with saline or aqueous chlorhexidine.
NB: Young or anxious children will require sedation prior to
wound repair See sedation
Management of tetanus-prone wounds
Antibiotics are not indicated for simple lacerations. They are
usually given for bites and wounds with extensive tissue damage, or
massive contamination, but are secondary in importance to the
initial decontamination of the wound. Recommended antibiotics are
procaine penicillin 25-50 mg/kg i.m. once and augmentin (10-20 mg
amoxycillin/kg) 8-hourly for 5 days.
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