Treating Child Lacerations
Going through a traumatic injury is tough, going through it with a child is even more difficult. Dr. Volshteyn, our board certified plastic surgeon specializes in the treatment and care if our younger generations. He handles precious cargo with the utmost care and attention to detail.
What is a laceration?
A laceration (cut) occurs when there is an interruption of the continuity of the skin. Depending on the sharpness of the object that caused the laceration, the edges may be jagged, dirty, or bleeding. Lacerations most often affect the skin, but any tissue may be lacerated, including subcutaneous fat, tendon, nerves, blood vessels, muscle, or bone.
If your child is currently in the emergency room, urgent care center, or in your primary care physician’s office, you need to know these important facts:
Most insurances will cover the use of a sub-specialist, such as a plastic surgeon, to repair a child’s laceration if one is available and willing.
You have the right to request a plastic surgeon to repair your child’s laceration. It does not guarantee the plastic surgeon will accept your request.
Most ER physicians and pediatricians advise repairing a child’s laceration within 8 hours, however with advanced techniques, plastic surgeons are able to repair the laceration up to 24 hours after occurrence.
Out of pocket costs depend upon the severity, location, size of the laceration and your child’s specific insurance policy.
Is there a difference in repair by a pediatric plastic surgeon vs. another physician?
This is a common question. Parents often seek the best outcome for their children after a laceration wound. Most plastic surgeons will trim the edges of a laceration to ensure the crushed and damaged tissues have been removed in order to decrease the scarring. Also, if the laceration starts in an unfavorable direction, additional advanced techniques can be utilized to change the direction of the laceration.
Most emergency room physicians and pediatricians will advise that the child’s laceration has to be repaired within 8 hours. This refers to the primary repair of the laceration without performing any correction of the tissue around the laceration. Plastic surgeons are able to repair pediatric lacerations up to 24 hours after occurrence, depending on the degree of swelling and contamination. In a case where swelling and contamination of the laceration is severe, the plastic surgeon will trim the skin edges and create a clean wound site.
We are available for emergency pediatric service in the Monmouth/Middlesex county area in New Jersey
Please call 732-641-3350 and Dr. Volshteyn will meet you and your child at one of the local emergency rooms, depending on the severity of the laceration and conditions of your insurance plan.
What if my child does not have insurance coverage or has a high deductible?
If your child is not covered by insurance or has a high deductible insurance policy, our practice is offering ALL CASH pricing. The price includes initial consultation, surgical treatment of laceration, procedural charge, equipment and supply charge, as well as up to 3 months follow up.
For exact fee, terms and how to do it, please see our CASH SERVICES page.
When should I seek medical attention for my child to repair a laceration?
Child lacerations should be repaired if any ONE of these apply:
continues to bleed after application of pressure for ten to fifteen minutes
is more than one-eighth to one-fourth inch deep or exposes fat, muscle,
tendon, or bone
causes a change in function surrounding the area of the laceration
is dirty or has visible debris
located in an area where an unsightly scar is undesirable
or near vital structures: nose, mouth, eyes, ears, etc.
Lacerations are less likely to become infected if they are repaired soon after they occur. Many physicians will not repair a laceration that is more than eight hours old because the risk of infection is too great. However, with more advanced techniques, they can be repaired even 24 hours later.
What is the procedure for a pediatric laceration repair?
The procedure is similar to repairing a tear in clothing. Pediatricians, emergency room physicians, and surgeons usually repair lacerations. The main goals are to stop bleeding, prevent infection, preserve function, and restore appearance.
Before repairing the laceration, your child is calmed and kept safe and secure. Then the physician thoroughly examines the child’s wound and the underlying tendons or nerves. If nerves or tendons have been injured, they may have to be repaired first. The laceration is cleaned by removing any foreign material or debris. Removing foreign objects from penetrating wounds can sometimes cause bleeding, so this type of wound must be cleaned very carefully. The wound is then irrigated with saline solution and a disinfectant. The disinfecting agent may be mild soap or a commercial preparation. An antibacterial agent may be applied.
Once the the child’s wound has been cleansed, the physician anesthetizes the area of the repair by injecting a local anesthetic. The surgeon may need to trim the jagged edges. To improve the healing process and future appearance, severely damaged tissues must be removed. If the child’s laceration is deep, several sutures are placed in the tissue under the skin to help bring the tissue layers together. Suturing also helps eliminate any pockets where tissue fluid or blood can accumulate. The skin is closed with sutures. Suture material used on the surface of a wound is usually non-absorbent to minimize the scarring. A light dressing or an adhesive bandage is applied for 24-48 hours. If the laceration is the result of a human or animal bite, if it is very dirty, or if the child has a medical condition that alters wound healing, oral antibiotics may be prescribed. If tetanus immunization is not up to date, a tetanus shot may be needed.
What can I expect after a pediatric laceration repair?
The child’s wound is kept clean and dry for at least 24 hours after the repair. Light bathing is generally permitted after 24 hours if the wound is not soaked. Sutures are removed after 3-14 days depending on the complexity and location of the wound.
We recommend cleaning the area twice daily with soap and water. Q-tips are helpful to gently clean along the suture line. Be extra careful around the child’s eyes. Due to a higher chance of allergic reaction, especially in children, we DO NOT routinely recommend the application of ointment such as Bacitracin or neomycin.
How can I help my child’s scar heal and improve over time?
One week after the child’s sutures are removed we recommend applying a sunblock SPF 30 or higher to prevent scar discoloration. During the early healing period the child’s scar will appear pink. During this stage the scar is very vulnerable to sun. Sun exposure even during cloudy days will eventually result in permanent darkening of the child’s scar (also known as solar tattooing).
To prevent discoloration and to ensure the scar is least noticeable, please continue to apply sunblock until the scar matures (pink color goes away). The pink color may stay up to 6-12 months.
The repair should be observed twice a day for signs of infection. This includes:
Drainage from the wound
Red streaks surrounding the repair
Fever or chills
If any of these occur, the physician should be contacted immediately.
What are the risks of a pediatric laceration repair?
The most common complication of any pediatric laceration repair is infection. Risk of infection can be minimized by cleansing the wound thoroughly. Wounds from bites or dirty objects or wounds that have a large amount of dirt in them are most likely to become infected.
All lacerations will heal with a scar. Wounds that are repaired with sutures are less likely to develop scars that are unsightly. The final result is unpredictable and unique to each child depending on conditions, severity of wound, and how their body heals.
If you would like to have a plastic surgeon repair your child’s cut, please inform the emergency room doctor or call your plastic surgeon’s office. Many private insurance companies will pay for a pediatric plastic surgery specialist.