Wounds

David M. Spiro; Mark R. Zonfrillo; Garth D. Meckler

doi:10.1542/pir.31-8-326

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David M. Spiro, MD, MPH*
Mark R. Zonfrillo, MD^†
Garth D. Meckler, MD, MSHS*

^*Section of Pediatric Emergency Medicine, Department of Emergency Medicine, Oregon Health and Science University, Portland, Ore.
^†Division of Emergency Medicine, Children's Hospital of Philadelphia, Philadelphia, Pa.

Author Disclosure
Drs Spiro, Zonfrillo, and Meckler have disclosed no financial relationships relevant to this article. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.

Objectives

After completing this article, readers should be able to:

Understand the epidemiology and pathophysiology of soft-tissue wounds in children.
Discuss the process of wound healing and factors associated with maximizing the cosmetic outcome of soft-tissue wounds.
Describe important aspects of wound evaluation, including relevant history and physical examination.
Recognize common complications of wound healing and approaches to minimize the risk of complications.
Explain the management of abrasions, puncture wounds, and lacerations, including techniques for cleansing and minimizing pain, as well as methods of closure.

Epidemiology and Overview

Unintentional injury remains the leading cause of morbidity and mortality for all pediatric age groups after the first postnatal year. Injuries are more frequent during summer months and occur twice as often in boys. Regardless of the mechanism, soft-tissue wounds, including abrasions, punctures, and lacerations, are the most common injuries sustained. Nearly 20% of pediatric emergency department visits are injury-related, and 2% of outpatient office visits are related to wound management. Complications of cutaneous wounds occur in up to 8% of children and include infection, hypertrophic scarring, and functional limitation. The primary goals of wound management are achieving hemostasis, identifying associated injuries, minimizing pain, promoting rapid healing, maximizing cosmesis, and avoiding complications. An understanding of the physiology, pathophysiology, and principles of evaluation and management of soft-tissue injuries is important for all primary care practitioners.

Pathophysiology of Wounds

The skin functions primarily as a barrier against the environment, helps to maintain thermal regulation and fluid balance, and protects against infection. The outer layer of skin is the epidermis, which is avascular and protects against desiccation through its keratinized surface. The dermis is composed of dense collagenous tissue; provides tensile …