Sections View Full Chapter Figures Tables Videos Full Chapter Figures Tables Videos Supplementary Content + • Improve cosmesis.• Reduce infection.• Restore function. + • Wounds on the trunk and torso that are greater than 12 hours old.• Wounds on the face that are greater than 24 hours old.• Puncture wounds.• Heavily contaminated wounds.• Bites, especially in areas of limited blood flow. + • Sterile gauze.• Sterile towels, drapes, and gloves.• Saline.• Sterile basin.• Detergent cleanser (Sur-Cleans) or povidone-iodine solution.• Suture material (Tables 42–1 and 42–2).• 30–60-mL syringe for irrigation (splash adapter optional).• Syringe with fine needle (25–30 gauge) for local analgesia infusion.• Suture scissors.• Needle holders.• Forceps with teeth.• Local anesthetic. ++Table Graphic Jump LocationTable 42–1. Surface wound closure guidelines.View Table|Favorite Table|Download (.pdf)Table 42–1. Surface wound closure guidelines.SiteSuture MaterialSuture RemovalFace6-0 absorbing or nonabsorbing5 daysScalp5-0 nonabsorbing7–10 daysDigits5-0 nonabsorbing7–10 daysPalms/soles2-0, 3-0, 4-0 nonabsorbing7–10 daysTorso4-0, 5-0 nonabsorbing7–10 daysJoint3-0, 4-0, 5-0 nonabsorbing10–14 days ++Table Graphic Jump LocationTable 42–2. Suture material.View Table|Favorite Table|Download (.pdf)Table 42–2. Suture material.NameMaterialReactivityStrengthAbsorption and CharacteristicsAbsorbableGutMonofilamentSevereGood7–10 daysFast absorbing gutMonofilament heat treatedModerateGood5–7 daysChromic gutMonofilament chemically treatedSevereGood10–14 daysPolyglycolic acid (Dexon)BraidedMildVery good60–90 daysPolyglactin 910 (Vicryl)BraidedMildVery good55–70 daysPolyglecaprone (Monocryl)MonofilamentMinimalVery good90–120 daysNonabsorbableSilkBraidedSevereGoodEasy to handle; ties wellNylon (Ethilon, Dermalon)MonofilamentMildVery goodSlippery; requires many knotsPolypropylene (Prolene)MonofilamentMinimalExcellentSlippery; requires many knots + • Infection.• Stitch extrusion. + • Suturing requires a calm and unhurried approach.• The practitioner should be comfortable, since preparation and closure of even small lacerations in children may require more time than initially expected.• Determine the circumstances and mechanism of injury (eg, blunt or sharp) and risk of contaminants or retained foreign body.• Obtain past medical history (including allergies, status of tetanus immunization, medication use, and chronic diseases), since specific medications, such as corticosteroids, and conditions, such as diabetes, delay wound healing. + • The patient should be lying flat or sitting. + • Figure 42–1 is a diagram of a skin laceration. ++Figure 42–1.Graphic Jump LocationView Full Size|Favorite Figure|Download Slide (.ppt)Diagram of skin laceration. + • Use universal precautions.• Document laceration length and depth.• Assess neurovascular status and investigate for tendon, muscle, or vascular injury.• Lidocaine is the most commonly used anesthetic for simple wound repair.• Epinephrine may be added to reduce local bleeding but is contraindicated in end organs (eg, penis, toes, fingers, nose, pinnae).• Sodium bicarbonate can be combined with lidocaine to reduce ... GET ACCESS TO THIS RESOURCE Sign In Username Error: Please enter User Name Password Error: Please enter Password Forgot Username? Forgot Password? Sign in via OpenAthens Sign in via Shibboleth Get Free Access Through Your Institution Contact your institution's library to ask if they subscribe to McGraw-Hill Medical Products. Access My Subscription GET ACCESS TO THIS RESOURCE Subscription Options Pay Per View Timed Access to all of AccessPediatrics 24 Hour $34.95 (USD) Buy Now 48 Hour $54.95 (USD) Buy Now Best Value AccessPediatrics Full Site: One-Year Individual Subscription $595 USD Buy Now View All Subscription Options