and frequently there is more devitalized tissue Therefore, these wounds are more likely to become infected and are often more difficult to repair Finally, compression injuries from blunt trauma perpendicular to the skin cause the most tissue disruption and devitalization These wounds are characterized by ragged edges, and lead to the highest infection rates and risk of scarring Cosmesis and Wound Healing Normal skin is under constant tension due to high collagen content Tension is also produced by underlying structures such as joints and muscles The amount of tension varies by anatomic location and position of a body part Lacerations that run parallel to joints and follow Langer lines of skin tension usually heal more quickly and with better cosmetic results Wounds under a large amount of tension, crossing joints, or perpendicular to wrinkle lines may heal with wide, or more, visible scars Lacerations regain about 5% of their previous strength weeks after injury, 30% after to months, and full tensile strength to months after the original injury Many factors, such as infection, tissue edema, and poor nutrition, may delay this progression All wounds deeper than the dermis have the potential for scar formation Scar formation involves the laying down of collagen, which is a complex process essential in restoring tensile strength of the skin Collagen synthesis begins within 48 hours of the injury and reaches a peak within the following week Anything that interferes with collagen synthesis, such as infection, may lead to wound dehiscence at this time Tissue contraction is expected with all healing wounds through the action of fibroblasts Therefore, eversion of suture lines is desired at the time of repair so the skin will contract to become flat after healing Remodeling may occur for up to 12 months The scar may fade and recede over the first months, and the final appearance of the scar may not be apparent until to months after injury Parental Satisfaction In general, there are many factors that influence parental and patient satisfaction with ED experience In the case of lacerations, as in any pain-inducing condition, parents are concerned that their child’s pain, both at presentation and during any repair, is addressed properly Additionally, parents are almost always concerned about the cosmetic outcome of the wound, particularly in the case of facial lacerations Communicating information about the healing process, the nature of the wound, and the expected cosmetic outcome, as well as the timeline for complete healing can help prevent dissatisfaction