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  • • 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 42–1. Surface wound closure guidelines.
Table 42–2. Suture material.

  • • 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.

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 pain associated with infusion.

    • When ...

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