The Children’s Hospital of Philadelphia Clinical Pathway Clinical Pathway for Evaluation/Treatment of Child With a Laceration URL: https://www.chop.edu/clinical-pathway/laceration-clinical-pathway Authors: S Fesnak, MD; E Friedlander, MD; E Lichtman, RN Posted: February 2019 GENERAL PRINCIPLES OF MINOR WOUND REPAIR The goals of wound repair are to obtain hemostasis, prevent infection, minimize pain, and achieve optimal cosmetic outcomes Obtaining Hemostasis Hemostasis is important not only to prevent ongoing bleeding but also for clear wound visualization prior to any repair Application of direct pressure with gauze is the fastest and most commonly used technique to obtain hemostasis If there is continued bleeding, applying a blood pressure cuff or tourniquet proximal to the wound for a short period is acceptable Injecting a local anesthetic with a vasoconstrictor such as epinephrine can help with hemostasis and can be safely used in areas of end-organ blood supply (e.g., digits, ear, nose, penis) despite traditional warnings of caution Prevention of Infection Bacteria inhabit normal intact skin This is the usual source of infection when skin tissue is disrupted The amount of bacteria on the skin varies by anatomic location High counts of bacteria are in moist areas such as the axilla and perineum, as well as in areas of exposed skin such as the hands, face, and feet Low counts of bacteria exist in dry areas such as the back, chest, and abdomen Areas colonized with high bacterial contamination are most prone to infection Wounds in regions of high vascularity, such as the scalp and face, are less prone to bacterial infection despite the high bacteria count The oral cavity is highly contaminated with bacteria, and this is an important source of infection when a child sustains a bite wound Wounds inflicted by shearing forces with a sharp object such as a knife cause minimal devitalization of adjacent areas and thus are less likely to lead to infection Wounds caused by a blunt object striking the skin at an angle of less than 90 degrees result in a tension injury such as an avulsion or flap These injuries involve a larger force applied to the skin than that of a shearing injury,