You know that feeling—when you least expect it your child manages to get a deep cut—and you know you’re headed for a long night in the ER. The good news is that the field of pediatrics has new and better ways to minimize pain and improve cosmetic outcome of skin wound treatments.
Skin glue is often an alternative to stitches. The main advantage of skin glue is that it is quick and virtually painless to use. Your child doesn’t need any injections of pain mediation and there are no needles involved. Skin glue can be a great option for a young child who would have to be sedated or restrained for a repair with stitches. Sometimes the cosmetic outcome may not be as good as a sewn repair, especially if the wound is in a high tension area. There are times when skin glue may not be possible, or may not be the best choice. Wounds that usually are not closed with skin glue include:
1) Wounds in areas of high skin tension such as the arm, leg or forehead.
2) Wounds in areas that stretch, move, or change such as over joints.
3) Wounds within a hairline such as scalp or through an eyebrow.
4) Wounds that have a high risk of infection such as animal bites.
5) Wounds that are particularly deep or large or involve damage to underlying muscle or tendons.
6) Wounds to mucus membranes, lips, and genitalia.
Skin numbing cream is also available and, for smaller wounds, can be the only medication needed to numb the area before stitches. This eliminates the need for injectable numbing medicines. The down-side to skin numbing creams is that they have to sit for at least 20-30 minutes before they are fully effective. But for small wounds that are not a candidate for skin glue, numbing cream and a few dissolving stitches means a nice cosmetic outcome with little or no trauma. Some doctors will also give a small, weight-adjusted dose of a narcotic and/or anxiety medicine to help make the process easier.
For larger wounds that need a lot stitches, some pediatric emergency rooms offer sedation. Your child can be put to sleep with IV medicine during the repair. If you think this might be necessary, call your ER first as not all facilities offer this service.
Some, but not all, ERs have a plastic surgeon on call. Other ERs have a list of plastic surgeons that they can call but do not guarantee that a plastic surgeon will be available. If you think you child may need a plastic surgeon, consider calling your ER first to see what their policy is.
No matter how your child’s wound is repaired, it will scar. If you are displeased with the scar, you can always have it revised by a plastic surgeon. And remember, the summer sun is the worst things for scars and prevents fading. Once your child’s wound is well healed, be sure to use liberal sun-screen every day.