Office Care of Wounds
John G. Lease MD1
1 Instructor in Plastic and Reconstructive Surgery, Department of Surgery, University of Chicago Hospitals, Chicago, IL 60637
All children experience a variety of minor injuries, the vast majority of which can be cared for easily by a competent parent. Wounds of a larger scope, wounds of a complex nature, or wounds with secondary complications require consultation with the pediatrician. Knowledge of the principles of treatment is essential and must be tailored to individual parental abilities, home environment, and emotional concerns. The purpose of this article is to outline common problems and to give suggestions for efficient office management.
Tetanus Prophylaxis
All wounds, regardless of etiology or size, should be considered as potential sources of tetanus. Therefore, it is incumbent upon the primary provider to ensure adequacy of tetanus prophylaxis (Table).
Lacerations
Pediatricians see a variety of lacerations. Those which do not come to medical attention through the emergency department are usually within the scope of the primary provider. Occasional surgical referral may be necessary because of the nature of location of the wound.
If bleeding has not ceased by the time of initial presentation, a small gauze dressing should be applied with direct, constant pressure for 15 min. Large, bulky dressings are inefficient for applying pressure at the exact bleeding site. Careful documentation should include location, orientation, depth, and exact length of the laceration.
