Appropriate use of sedation and local anesthetics is essential for successful repair of lacerations in some children Some younger children can undergo repair after being placed in a restraining device, such as a papoose board, or wrapping the child securely but comfortably in a bedsheet for better immobilization Restraint is needed to ensure the child’s safety and allow for more rapid completion of the procedure Because the child may get excessively warm while being restrained, it is important to ensure proper ventilation and assess the child’s comfort during the restraint process A caring, but firm assistant is often needed to further immobilize the injured body part and complete the procedure successfully It is better to use such hospital personnel instead of parents to immobilize a child A school-age child can usually cooperate without restraint Some children may require procedural sedation and/or anesthesia depending on the type, extent and location of the wound, and the child’s age and level of development (see Chapter 129 Procedural Sedation ) Some extensive wounds may warrant more significant repair that is best accomplished with surgical consultation and possible intraoperative repair Minimizing Risk of Infection Hair near the wound usually creates minimal difficulty during repair Shaving the hair in the area of the wound may damage hair follicles and increase risk of infection If necessary to facilitate repair, the hair should be clipped with scissors Alternatively, petroleum jelly can be used to keep unwanted scalp hair away from the wound while suturing Hair over the eyebrows should never be removed because this may lead to abnormal or slow regrowth It is essential to clean the wound periphery at the time of wound evaluation Povidone-iodine solution (a 10% standard solution) is often used because it is a safe and effective antimicrobial with little tissue toxicity This solution may be diluted with saline 1:10 to create a 1% solution Use of chlorhexidine or povidone-iodine surgical scrub preparations, hydrogen peroxide, or alcohol in the wound itself is not recommended These may be irritating to tissues and may injure white cells, increasing the risk of infection Wound irrigation is extremely important to reduce bacterial contamination, remove any particular matter, and prevent subsequent infection It is often necessary to anesthetize the wound before thoroughly cleansing Using universal precautions, the wound should be irrigated with normal saline, approximately 100 mL/cm of laceration More may be needed if the wound is unusually large or contaminated Use a large syringe (20 to 60 mL) with a splash guard (commonly 20-gauge bore) attached to the end to reduce splatter during the irrigation With