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Chapter 2 Index
A. Evaluation by system B. Other categories of illnesses:
1. Metabolic and Endocrine
2. Collagen-Vascular Illnesses
3. Chromosomal Abnormalities
4. Generalized
5. Sexual Abuse
6. Hematology 7.
Trauma and Surgery
--Surgery in
Pediatrics: Timing and Indications for Procedures
--Fractures in Children
--Evaluation of Ankle Injuries
--Splinting and Casting |
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Suturing by the Pediatrician
David Rogers, MD - Pediatric Surgery
How do you decide if a child needs sutures? See fat peeking through; must remember to clean vigorously
to see exactly how deep laceration is.
When should a pediatrician not suture?
- laceration crosses vermilion border of the lip
- ragged laceration of face in young child
- laceration more than 24 hours old
- human bite: try not to suture even if deep
- dirty wounds that you cannot get clean
- parents are particularly difficult: you don’t know them they are constantly asking you if you are
qualified they work in a tertiary center and want a plastic
surgeon to do it
- contaminated wounds from gravel
- very few digits need to be sutured: steri-strip, butterfly, pressure:
better results
What is the procedure of suturing?
- with or without epinephrine: do not use epinephrine when
sewing fingers or toes
- after anesthetic, decide whether to close the deep layer and steri-strip
the skin or actually close. If latter, choose nylon or silk:
advantages and disadvantages
- choose size: 5-0 for face; 4-0 for extremities, and
scalp
- before suturing and after anesthetic, clean wound with
gentle irrigation; betadine is controversial.
- can choose mattress suture/ or interrupted sutures - not
continuous sutures.
When do you remove sutures? face 4 days; extremities 7-8 days.
Instructions upon leaving the office:
- do not let sutures get wet
- if inflammation starts, use peroxide with Q-tip to wash over sutures
2-3 X/day
- if pus develops, bring child back for treatment.
- role of prophylactic antibiotics: none
Complications of suturing: Infection, infection, infection; keloids,
scars
Infection: try to prevent by always issuing instructions on leaving the
office about cleansing and keeping area dry. Options if infected:
- remove alternate sutures
- remove all sutures
- start antibiotics: if human bite use plain penicillin or Augmentin
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