- 1 Description
- 2 Options
- 3 Indications and Types
- 4 Evaluation
- 5 Surgical Options
- 6 Repair Procedure
- 7 Recovery
- 8 Frequently Asked Question (FAQs)
- 8.1 What is a laceration?
- 8.2 How will a laceration be diagnosed for my child?
- 8.3 How should I treat my child’s laceration before I take them to the ER?
- 8.4 What will happen when I get to the Emergency Room?
- 8.5 How will my child’s laceration be closed?
- 8.6 Will my child need a tetanus shot?
- 8.7 What are the risks of a laceration?
- 8.8 What are stitches and why are they used to close a laceration?
- 8.9 What are Steri-Strips?
- 8.10 How will I know if my child’s cut needs stitches?
- 8.11 After my child’s laceration is repaired, when can the wound get wet?
- 8.12 Should I use an antibiotic ointment on my child’s wound?
- 8.13 Will my child be prescribed an oral antibiotic?
- 8.14 Will my child have a scar?
- 8.15 When is plastic surgery necessary for my child’s laceration?
There is nothing more precious than your child. For this reason, it is vital to ensure that if they ever suffer any injury, children are cared for by a physician with a meticulous attention to detail, the finest surgical and medical technique and an ability to communicate and empathize with an injured child. Dr. Gabbay has a deep-rooted medical background in the care and treatment of children. He is known in the community for his gentle and caring bedside manner with kids, and is known internationally for his cutting edge research in advancing pediatric plastic surgical techniques.
In the United States, trauma is the most common cause of disability in the pediatric population. Treating an injured child requires meticulous care, scrupulous attention to detail, and a constant commitment to staying up-to-date with modern technology and advanced techniques. Over one million children suffer lacerations (skin cuts) that require stitches in the emergency room each year. Repairing lacerations of an injured child requires a special skill set, and a doctor with a versatile background and comforting bedside manner, in order to assuage the fears of the child in pain.
Having a plastic surgeon treat childhood lacerations is generally the best treatment choice, because plastic surgeons are able to care for your child’s physical health, while simultaneously taking all measures to ensure minimal scarring, and produce the optimal cosmetic results after the injury has healed. At Gabbay Plastic Surgery, located in Beverly Hills, CA, Dr. Joubin Gabbay M.D. frequently treats children with a multitude of different types and sizes of lacerations. Dr. Gabbay works incredibly well with children of all ages, and helps them to feel safe and comfortable while utilizing cutting edge surgical techniques to minimize their pain and ensure any scarring is as inconspicuous as possible. Dr. Gabbay minimizes potential for childhood scarring by revising the skin edges around the injury, and closing the wound in layers, in order to result in a more aesthetically pleasing outcome.
Traditionally, sutures have been used for laceration repair; however, other options in the outpatient setting include: tissue adhesive strips, tissue glue, advanced wound healing agents and other topical treatments. Whatever the material used, preliminary wound care requires an expansive working knowledge of all available techniques, and the ability to select the appropriate wound-closing option to obtain optimal results.
Having an injured child can be a heart-wrenching and traumatic experience, not only for the child, but for the parent as well. During this stressful time, it can be a tremendous relief knowing that your child’s doctor is an incredibly skillful technician, with the ability and empathy to minimize your child’s suffering, as well as any future scarring. Dr. Gabbay has years of experience, and vast knowledge and training working with pediatric patients, and he will do everything possible to ease your worries and restore your child to good health. For more information about pediatric laceration treatment, please contact Gabbay Plastic Surgery today—we are happy to answer any questions and to schedule an initial, complimentary consultation with Dr. Gabbay.
Indications and Types
A wound is a break in the continuity of the skin caused by violence or trauma to the tissue.
The indications of a laceration include:
- Edges of the wound are irregular, ragged and often bruised
- Margins of the wound are rough
- Strands of the tissues bridge across the deeper parts of the laceration
- Foreign material may be found in the wound
The types of lacerations include:
- Split Lacerations—produced by crushing of the skin and subcutaneous tissues between two hard objects
- Stretch Lacerations— occurs when an overstretching of the skin tears, producing a flap of skin in the direction of the injury due to tangential impact
- Avulsions—a separation of the skin due to grinding compression of the tissues
- Tears—caused by an irregularly directed impact with a blunt object, causing actual tearing of the skin.
- Chop Lacerations—produced by weapons with sharp, heavy edges
- Sheer Laceration—caused by sharp objects such as a knife blade or glass
- Tension Laceration—occurs when the skin tears after striking a flat surface
- Compression Laceration—occurs when the tissue is caught between a bone and an external hard surface, causing the skin to burst and a stellate (star-shaped) patterned wound
- Combined Laceration—has the characteristics of both sheer and compression lacerations, and is typically a linear wound with crushed edges
Pediatric lacerations require repair if they meet any of the following criteria:
- Bleeding continues after the wound has been cleaned with warm water and antibacterial soap and you have applied pressure for 10–15 minutes.
- The wound is more than one-eighth to one-fourth inch deep
- The cut exposes fat, muscle, tendon, or bone.
- There are changes in the surrounding area of the laceration (i.e. red streaks or drainage)
- The laceration is located in an area where a scar would be undesirable.
- Dirt and debris can be seen in the wound after irrigation and cleaning.
- It feels as if something is in the wound even if you cannot see any debris.
- The wound is at risk for developing tetanus
- Your child has not received a total of at least three doses of tetanus immunization, or it has been more than five years since their last tetanus immunization
- The edges of the wound are jagged or uneven
- The wound is located over a joint, and/or extends into a joint-space (i.e. knee, knuckle, wrist, and ankle
- The wound is located at an area of high stress (joints, hands, feet, chest)
- There is extreme swelling
If you are interested in learning more about pediatric laceration repair, please call Gabbay Plastic Surgery and let us schedule your personal consultation with Dr. Gabbay. During your meeting, Dr. Gabbay will discuss your overall expectations in order to determine whether pediatric laceration repair is appropriate for your child. You should come to your consultation prepared to discuss your child’s medical history (including any past surgeries), present medical conditions, allergies, and medications.
It is imperative that you provide complete information, as numerous medical conditions can potentially increase the risks and complications associated with surgery. If Dr. Gabbay feels that your child is a good candidate for pediatric laceration surgery, he will explain the different techniques, costs and potential side effects before scheduling the procedure. When choosing Dr. Gabbay, you can be assured that your child is in the hands of a surgeon who has undergone extensive training and is highly esteemed by his colleagues and patients alike.
Laceration repair treatment options include:
- Sutures: used for wounds that are deep, bleeding, have jagged edges, or have fat or muscle exposed
- Staples: best suited for the scalp, neck, arms, legs, torso, and buttocks
- Topical Skin or Tissue Adhesives (i.e. Dermabond): appropriate for mild to moderate lacerations, is applied in three coats, and can be utilized in conjunction with stitches
- Adhesive Surgical Tape or Strips (i.e. Steri Strips): primarily used for minor lacerations
Once the wound has been cleansed, Dr. Gabbay will use a numbing cream and lidocaine to anesthetize the treatment area. He will then trim any jagged or uneven edges around the wound, and remove any damage tissue to prevent infection. For deep lacerations, absorbable stitches will be placed within the tissue, in order to close the tissue layers and eliminate any pockets where fluid or blood could accumulate. A light dressing and/or antibiotic ointment will be applied for 24-48 hours, and if the laceration is the result of a human or animal bite, or if the child has a medical condition that inhibits wound healing, a broad-spectrum antibiotic may be prescribed. Dr. Gabbay takes great care to make the experience comfortable for each child, and to minimize any post-procedural scarring.
Following you child’s procedure, you will be given antibiotics and pain medication (if necessary), and you will also be given instructions for how to care for your child at home. Stiches, surgical tape and staples will be removed within 1-2 weeks, and tissue adhesives will fall off on their own in 5-10 days. It is important that you do not try to remove the closure materials yourself, as this may lead to infection, scarring, or the re-opening of the wound. It is important that you keep your child from picking or scratching their wound, as this can lead to infection, and can exacerbate the severity of the scar.
Although rare, potential complications of pediatric laceration repair include: infection, bleeding, pain, swelling, noticeable scarring, poor wound closure, and adverse reaction to anesthesia.
Frequently Asked Question (FAQs)
What is a laceration?
A laceration implies a torn or jagged wound that tears or opens the skin. The cut may only effect the first layer of skin (epidermis) or it may travel through the skin, damaging blood vessels, underlying layers of fat and tissue, muscles, and bone requiring emergency medical care.
How will a laceration be diagnosed for my child?
You will be asked about your child’s injury, and the wound will be examined thoroughly. In some cases, additional tests may be required, including an X-ray or other imaging procedures.
How should I treat my child’s laceration before I take them to the ER?
You should calm your child and let them know that you will get help, if necessary. Apply pressure with a clean cloth or bandage to stop the bleeding, and if the cloth becomes soaked with blood or if it the bleeding doesn’t stop, you should seek medical assistance immediately.
What will happen when I get to the Emergency Room?
At the hospital or clinic, the wound will be cleansed to decrease the chance of infection, and it will be checked for foreign objects and debris. Before the wound is closed, the area will be numbed to decrease the pain.
How will my child’s laceration be closed?
Depending on the type of wound and the damage involved, your child’s laceration may be closed with stitches, staples, tissue glue, or medical strips. These techniques will help to keep the wound from getting infected, and stitches may decrease the amount of scarring.
Will my child need a tetanus shot?
Tetanus infection can happen after any break in the skin, and if it has been longer than five years since your child had a tetanus shot, the chances are good that they will need one. Wounds at high risk for tetanus infection include any wound that may have dirt or saliva in it, and they should be given as soon as possible, at least within 72 hours of the injury.
What are the risks of a laceration?
A laceration may have a foreign object in it even after the wound has been cleaned, increasing the chances for infection. Without treatment, the laceration may become infected, function may be permanently impaired if nerve or tendon damage is involved, and the scar will be disfiguring if not closed properly.
What are stitches and why are they used to close a laceration?
Stitches, also called sutures, are special types of thread that hold wound edges together while they heal. Stitches help to stop bleeding, reduce scarring, and decrease the chance of infection in the wound.
What are Steri-Strips?
Steri-Strips are sterile adhesive strips that can sometimes be used on small, shallow wounds instead of stitches and they perform the same functions as stitches.
How will I know if my child’s cut needs stitches?
Lacerations that are longer than 1/2 inch, are deep, or are bleeding heavily typically require stitches.
After my child’s laceration is repaired, when can the wound get wet?
After being treated, it is best to keep your child’s wound dry for the first 24 hours so the wound edges have a chance to start healing. Gentle cleaning with soap and water is okay after that time frame as long as the healing cut is not submerged in water, and keeping the wound clean and dry will ensure proper healing.
Should I use an antibiotic ointment on my child’s wound?
This will depend on what Dr. Gabbay advises, but most often a topical antibiotic can be used to decrease the risk of infection and speed up the healing process.
Will my child be prescribed an oral antibiotic?
In most cases, oral antibiotics are not necessary if the wound is cleaned and repaired properly, however, in certain contaminated wounds, antibiotics are required because the risk of infection is high.
Will my child have a scar?
Although some scars fade away after many years, all lacerations will cause a scar, and the visibility will be determined by the immediate care received after the injury. Other factors that determine scar visibility are the location of the wound, its position, size and shape, and if the wound was repaired by a qualified plastic surgeon such as Dr. Gabbay.
When is plastic surgery necessary for my child’s laceration?
Some lacerations are especially complicated and require a surgical specialist. The primary reasons are because the wound is very deep, irregular, and dirty requiring special equipment; or if the wound is on a cosmetically important part of your child’s body.