Anesthesia, copious irrigation, and tension-free approximation are vital to a successful closure Subspecialty consultation may be warranted for latepresentation lacerations or heavily contaminated wounds, in which the risk of infection is high If possible, facial lacerations should be repaired using buried absorbable sutures, to reduce tension on the wound and to help with eversion of the edges All wounds contract as scar formation occurs and thus eversion of the skin should be achieved for facial lacerations, particularly those involving the nares, eyelids, helix of the ear, and vermilion border of the lower lip Inadequate eversion of the wound edges at these sites may lead to a depressed scar or notching at the site of the laceration For simple scalp lacerations, stapling is a fast and cosmetically acceptable alternative to suturing Repair of complex injuries to laminated structures (e.g., ear, eyelid, nose, lip) requires that each layer of the structure be reapproximated For example, a fullthickness laceration to the nose at the nostril rim requires closure of three separate layers The nasal lining is usually closed first with an absorbable suture material Next, the cartilage must be repaired, also with absorbable material Finally, the overlying skin of the nose can be reapproximated Similarly, complex injuries of the ear, the eyelid, or the lip require layered closure to achieve the best cosmetic result Careful attention should be paid to lip lacerations that traverse the vermilion border Cosmetic outcome is predicated on successful alignment of tissue at this junction Subspecialty consultation may be considered for lacerations involving the external ear, nasal mucosa and cartilage, as well as complex lip lacerations traversing the vermilion border Informed consent should be obtained from patients and families undergoing laceration repair, and this information should be documented in the medical record The physician should provide a careful assessment and natural history of the injury if left untreated to heal on its own The physician should also describe the recommended treatment, as well as alternative treatments, with likely outcomes and possible complications Patients with lacerations resulting from dog bites and those who present for care after a delayed period of time should be advised of the high risk of infection Complicated facial laceration repair and laceration repair in young children may be facilitated by the use of a short-acting benzodiazepine or procedural sedation Current Evidence Randomized controlled trials that compared fast-absorbable plain catgut to nonabsorbable nylon sutures have demonstrated no significant difference in short-