New concepts in wound management

Children with lacerations and other minor wounds are among the most often encountered in the ED. The steps in management of these patients are well-known and often well-researched, but dogma still permeates the process. Local anesthetics are effective, and several choices are available. New topical creams and expanded indications for the currently available anesthetics will enhance patient comfort during laceration cleaning and repair. Irrigation with tap water is a safe, effective and economic method of cleaning wounds, and perhaps even the use of sterile gloves is superfluous in preventing wound contamination. Several alternative wound-closure materials are currently available including tissue adhesive in an array of applicators and formulations, adhesive strips, staples, and nonabsorbable as well as absorbable suture material. Finally, prophylaxis for tetanus is a simple, if possibly underused, technique. Further research into new materials and procedures will only improve our care of patients who have sustained skin trauma.