Approximately 11 million wounds are treated in emergency departments in the United States annually . Most wounds in children occur on the head, and the most common mechanism of injury is application of blunt force [2,3]. Management of these minor wounds has two goals: avoidance of infection and achievement of a functional scar that is cosmetically acceptable . Preliminary wound management includes assessment, adequate hemostasis, hair removal, and local anesthesia. Assessment, hemostasis, hair removal, and irrigation are reviewed here. The administration of local anesthesia and wound closure are discussed separately. (See "Topical anesthetics in children" and "Infiltration of local anesthetics" and "Closure of skin wounds with sutures".)
Wounds that involve joints, nerves, flexor tendons, or other underlying structures may require operative care and are not considered minor wounds [2,4].
The assessment of minor wounds includes determination of allergies (eg, to local anesthetics, antibiotics, or latex), status of tetanus immunization (table 1), mechanism of injury, presence of foreign body, extent of the wound, neurovascular or tendon injury, and cosmetic significance of the wound. (See "Allergy to penicillins" and "Tetanus".)
Age of injury — The optimal length of time between injury and laceration repair has not been adequately defined. The most frequently quoted study examining this question involved 372 patients (204 of whom returned for review seven days later) who underwent suture repair of wounds that were not grossly infected and had no associated injuries to nerves, blood vessels, tendons, or bone . The following results were reported:
- Wounds closed at up to 19 hours after injury had a significantly higher rate of healing than those closed later (92 versus 77 percent).
- In contrast to wounds involving other body areas, the healing of head wounds was virtually independent of time from injury to repair: 42 of 44 (96 percent) wounds involving the head and repaired later than 19 hours after injury were healing, compared with 47 of 71 (66 percent) of all other wounds. In general, a facial wound can be closed up to 24 hours later with little risk of infection if it is reasonably clean .