1. Patient/family understands return precautions, home care and follow-up after laceration repairs.
2. If patient was sedated for repair, please see special sedation recovery guidelines for discharge (standard ED requirements).

• Surgically repaired wounds should be followed up at the discretion of the repairing subspecialty.
• All bite wounds should be seen by PCP or emergency wound within 48 hours of repair.
• Any wound with progressive redness, swelling, pain, drainage or fever should be followed up immediately.

• Wounds heal with a scar; the scar should remodel itself in the first 6 months after the injury. Be sure to use extra SPF sunscreen on scars to prevent discoloration when in the sun.
• Mild swelling and redness are common with all wounds and normally will go away as the wound heals. If redness and swelling continue to increase more than 48 hours post-repair, call your doctor.
• Sometimes your child may need to be a given a tetanus booster based on the mechanism of how the laceration was sustained. If your child was given a tetanus shot in the Emergency Department, inform your doctor to update your child's records.

• Steri-Strips^™: Your child's doctor used adhesive paper tape (Steri-Strips) to close the wound. Allow these to fall off by themselves (usually in 5-7 days). Do not soak the wound in water or allow your child to swim with Steri-Strips. Keep the wound clean and dry. If they start to curl at the end, you may trim them, but do not peel them off.
• Staples: No dressing is required. Schedule removal in 7-10 days with pediatrician or return to ED. A staple removal kit may be provided by the ED when you get them placed.
• Skin-glue adhesive: Typically falls off in 5-7 days
  1. For Dermabond^®: Your child’s wound was treated with Dermabond Topical Skin Adhesive. This is a sterile, liquid, skin adhesive that holds wound edges together. The film will usually stay in place for 5 to 10 days, then fall off.
  2. The following will answer some of your questions and provide instructions for proper care for your child’s wound while it is healing:
     • Do not scratch, rub, or pick at the Dermabond. This may loosen the film before your child’s wound is healed.
     • Do not place tape directly over the Dermabond. Removing the tape may also remove the film.
     • Do not let the wound be in direct sunlight or tanning lamps for long periods of time.
     • Do not apply liquid or ointment medications or any other product to your wound while the Dermabond is in place. This may loosen the film before the wound is healed.
• Sutures: Washing with a washcloth at the sink is OK. Do not take a bath, soak the stitches, or allow your child to swim with the stitches. Antibiotic ointment may be prescribed to apply to the site. If they should loosen, or if the wound pops open, bring your child back to the Emergency Department. If it starts bleeding, apply direct pressure for 15 minutes. If it continues to bleed, call your doctor or return to the ED.
  1. Absorbable sutures: These dissolve in 3-5 days. It is OK to remove any residual material after that.
  2. Non-absorbable sutures: These require removal by your primary care doctor or an ED physician.
     • Eyelids: 3 days
     • Neck: 3-4 days
     • Face: 5 days
     • Scalp: 7-14 days
     • Nail beds: 10-14 days
     • Trunk & upper extremities: 7 days
     • Lower extremities: 8-10 days

Instructions to keep your wound protected

Call Your Doctor or Return to the Emergency Department for Any Signs of Infection:

2. Scar Care

Scars form whenever something disrupts/alters the natural skin, for example:

Once the skin has been disrupted, the body heals by lying down fibrous or connective tissue that causes a scar to form. Scars usually take about 12–18 months to fully mature. During that time, they go through a remodeling process. In the first few months, they may be pink and raised (hypertrophic) then soften, flatten and lighten over the remaining 9–10 months. Scar tissue is not as strong as normal skin, and therefore, depending on location, direction and tension, it may widen over time, no matter how carefully the wound was closed. Some scars may even remain permanently thick (hypertrophic) or form an excessive amount of scar tissue (keloid) despite best efforts to minimize scarring.

If the incision has been closed with absorbable sutures and Steri-Strips, scar treatment can begin about 2 weeks later after the Steri-Strips have been removed and the incision is completely healed. If permanent sutures were used and suture removal is necessary, scar treatment can begin after suture removal according to the provider's recommendations.

Treatment of Scars

There are many ways to treat a scar:

If you have questions about any of the clinical pathways or about the process of creating a clinical pathway, please contact us.

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The clinical pathways are based upon publicly available medical evidence and/or a consensus of medical practitioners at The Children’s Hospital of Philadelphia (“CHOP”) and are current at the time of publication. These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioner’s professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

Accordingly, these clinical pathways are not intended to constitute medical advice or treatment, or to create a doctor-patient relationship between/among The Children’s Hospital of Philadelphia (“CHOP”), its physicians and the individual patients in question. CHOP does not represent or warrant that the clinical pathways are in every respect accurate or complete, or that one or more of them apply to a particular patient or medical condition. CHOP is not responsible for any errors or omissions in the clinical pathways, or for any outcomes a patient might experience where a clinician consulted one or more such pathways in connection with providing care for that patient.