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Current concepts in laceration repair
1Pediatric Emergency Services, Geisinger Medical Center, Danville, PA 17822-3102, USA.
Insights
New methods for pediatric laceration repair offer improved sedation, painless anesthesia, and rapid closure. These advancements, including fentanyl oralet, topical anesthetics, and tissue adhesives, enhance patient care and outcomes.
Area of Science:
- Pediatric Emergency Medicine
- Wound Care
- Anesthesiology
Background:
- Pediatric lacerations frequently necessitate emergency department visits.
- Children's unique characteristics present challenges in laceration repair, demanding speed, simplicity, and minimal pain.
Purpose of the Study:
- To review recent advancements in pediatric laceration repair techniques and pharmacologic agents.
- To highlight innovations improving sedation, local anesthesia, and wound closure for children.
Main Methods:
- Review of new pharmacologic sedation modalities, including fentanyl oralet.
- Evaluation of topical anesthetic formulations (e.g., tetracaine, adrenaline, cocaine; lidocaine, epinephrine, tetracaine).
- Assessment of novel tissue adhesives (e.g., Histoacryl Blue, Dermabond) for laceration closure.
Main Results:
- Fentanyl oralet provides effective sedation for pediatric procedures.
- Topical anesthetics offer a safe, painless alternative to lidocaine infiltration.
- Tissue adhesives are easy, rapid, painless, and yield acceptable cosmetic results, eliminating suture removal.
Conclusions:
- Recent innovations significantly improve pediatric laceration management.
- New sedation, anesthesia, and closure techniques enhance patient comfort and procedural efficiency.
- Tissue adhesives represent an ideal closure method for pediatric lacerations, offering multiple benefits.
Abstract:
Lacerations account for a significant number of emergency department and urgent care clinic visits for pediatric patients. Children represent a unique challenge in repairing lacerations because of their developmental and behavioral characteristics, making rapidity, ease of performance, and minimal pain particularly desirable. This review focuses on three concepts in laceration repair where there have been significant advances in the past several years in terms of new techniques and drugs. New pharmacologic modalities such as the fentanyl oralet for sedation of children are discussed as well as important nonpharmacological techniques such as parental presence. Topical administration of anesthetics such as tetracaine, adrenaline, and cocaine and lidocaine, epinephrine, and tetracaine offers the advantage of replacing lidocaine infiltration and provides an effective, safe, and painless alternative for local anesthesia. Finally, the introduction of cyanoacrylate tissues adhesives such as Histoacryl Blue (Trihawk International, Montreal, Canada) and Dermabond (Ethicon, Somerville, NJ) appear to be an ideal technique for laceration closure in children because they are easy and rapid to apply, are relatively painless, eliminate the need for suture removal, and provide an acceptable cosmetic result.
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