Clinical Pathways
Clinical Pathways
No fracture or foreign body
No fracture or foreign body

No fracture or foreign body

View The Full Pathway

Decision

Are any of the following factors present?

  • Neurovascular injury/compromise
  • Joint involvement
  • Tendon/muscle injury
  • Amputation
  • Blast or high-pressure injuries

Yes

  • Consult specialist based on laceration location, mechanism of injury, deeper structure involvement, local availability, and hospital policy

No

  • Proceed with primary closure:
    • Administer anesthesia, topical and/or injectable (Class I)
    • Irrigate with normal saline or tap water (Class I)
    • Choose closure technique
  • Discharge patient with instructions:
    • Keep wound clean (Class II)
    • Safe to shower 12 hours after wound closure (Indeterminate)
    • Advise on follow-up for suture/staple removal, if needed
    • Advise the patient to avoid sun exposure to wound; once closure method is removed, apply sunblock to area when outdoors (Class III)

Background

Sutures

Among all wound closure methods, sutures are the strongest and most versatile, and allow for the most accurate approximation of wound edges. The first step in suturing is to determine which type of suture to use: absorbable or nonabsorbable. Absorbable sutures are made of synthetic polymers or collagen and are eventually degraded by enzymes, losing tensile strength within 60 days. An advantage of absorbable sutures is that patients do not need to return to the ED for suture removal. Nonabsorbable sutures are nonbiodegradable and maintain their tensile strength for >60 days. They are most often used to close the outermost layer of skin and are generally avoided in deep vascularized tissues. Monofilament material (nylon, polypropylene) is preferred for nonabsorbable sutures due to its strength and relatively low tissue reactivity. Absorbable sutures are noninferior to nonabsorbable sutures for patient satisfaction and cosmetic outcome. Some studies (although limited) showed no significant difference in any aspect of cosmesis, patient satisfaction, or infection when comparing absorbable and nonabsorbable sutures for facial wounds.

The decision to use a specific suture type is often guided by the wound location. For high-tension wounds that will require suture strength for a longer period, the preferred material is polyglyconate (absorbable monofilament). For facial wounds, a fast-absorbing gut suture is best, as its time of retention of tensile strength and time needed for wound healing are similar. Suture size also matters because of the potential for cosmetic injury. The smaller the suture size, the lower the tensile strength; larger-diameter material produces more damage to the tissue and leaves larger holes in the skin, so the thinnest suture material should be used while ensuring appropriate tensile strength.

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References
  1. García-Gubern CF, Colon-Rolon L, Bond MC. Essential concepts of wound management. Emerg Med Clin North Am. 2010;28(4):951-967. (Review)
  2. Nazzal M, Osman MF, Albeshri H, et al. Wound healing. In: Brunicardi FC, Andersen DK, Billiar TR, et al, eds. Schwartz’s Principles of Surgery, 11th ed. McGraw-Hill Education; 2019. (Textbook chapter)
  3. Strecker-McGraw MK, Jones TR, Baer DG. Soft tissue wounds and principles of healing. Emerg Med Clin North Am. 2007;25(1):1-22. (Review)
  4. Mankowitz SL. Laceration management. J Emerg Med. 2017;53(3):369-382. (Review)
  5. Rui P, Kang K. National Hospital Ambulatory Medical Care Survey: 2017 emergency department summary tables. 2017. Accessed November 15, 2021. (Government data set)
  6. Singer AJ, Thode HC Jr, Hollander JE. National trends in ED lacerations between 1992 and 2002. Am J Emerg Med. 2006;24(2):183-188. (Retrospective systematic review) DOI: 10.1016/j.ajem.2005.08.021
  7. Pfaff JA, Moore GP. Reducing risk in emergency department wound management. Emerg Med Clin North Am. 2007;25(1):189-201. (Review) DOI: 10.1016/j.emc.2007.01.009
  8. Bohjanen K. Structure and functions of the skin. In: Soutor C, Hordinsky MK, eds. Clinical Dermatology. McGraw-Hill Education; 2017. (Textbook chapter)
  9. Garza L. Developmental biology of the skin. In: Kang S, Amagai M, Bruckner AL, et al, eds. Fitzpatrick’s Dermatology, 9th ed. New York, McGraw-Hill Education; 2019. (Textbook chapter)
  10. Provencher MT, Allen LR, Gladden MJ, et al. The underestimation of a glass injury to the hand. Am J Orthop (Belle Mead NJ). 2006;35(2):91-94. (Case series; 34 patients)
  11. Nylén S, Carlsson B. Time factor, infection frequency and quantitative microbiology in hand injuries: a prospective study. Scand J Plast Reconstr Surg. 1980;14(2):185-189. (Prospective study; 89 patients)
  12. Baldwin G, Colbourne M. Puncture wounds. Pediatr Rev. 1999;20(1):21-23. (Review)
  13. American College of Surgeons Committee on Trauma. Advanced Trauma Life Support: Student Course Manual, 10th ed. 2018. (Course manual)
  14. The American College of Surgeons. Stop the Bleed. 2021. Accessed November 15, 2021. (Website)
  15. Tran H, Anand SS. Oral antiplatelet therapy in cerebrovascular disease, coronary artery disease, and peripheral arterial disease. JAMA. 2004;292(15):1867-1874. (Review)
  16. Talan DA, Abrahamian FM, Moran GJ, et al. Tetanus immunity and physician compliance with tetanus prophylaxis practices among emergency department patients presenting with wounds. Ann Emerg Med. 2004;43(3):305-314. (Prospective observational study; 1988 patients)
  17. Quinn JV, Polevoi SK, Kohn MA. Traumatic lacerations: what are the risks for infection and has the ‘golden period’ of laceration care disappeared? Emerg Med J. 2014;31(2):96-100. (Prospective study; 2663 patients)
  18. Hollander JE, Singer AJ, Valentine SM, et al. Risk factors for infection in patients with traumatic lacerations. Acad Emerg Med. 2001;8(7):716-720. (Cross-sectional study; 5521 patients)
  19. Capellan O, Hollander JE. Management of lacerations in the emergency department. Emerg Med Clin North Am. 2003;21(1):205-231. (Review)
  20. Lammers RL, Hudson DL, Seaman ME. Prediction of traumatic wound infection with a neural network-derived decision model. Am J Emerg Med. 2003;21(1):1-7. (Prospective cohort study; 1142 patients)
  21. Davis J, Czerniski B, Au A, et al. Diagnostic accuracy of ultrasonography in retained soft tissue foreign bodies: a systematic review and meta-analysis. Acad Emerg Med. 2015;22(7):777-787. (Systematic review and meta-analysis; 17 articles) DOI: 10.1111/acem.12714
  22. Manthey DE, Storrow AB, Milbourn JM, et al. Ultrasound versus radiography in the detection of soft-tissue foreign bodies. Ann Emerg Med. 1996;28(1):7-9. (Randomized blinded descriptive study)
  23. Ipaktchi K, Demars A, Park J, et al. Retained palmar foreign body presenting as a late hand infection: proposed diagnostic algorithm to detect radiolucent objects. Patient Saf Surg. 2013;7(1):25. (Case report; 1 patient)
  24. Singer AJ, Mach C, Thode HC Jr, et al. Patient priorities with traumatic lacerations. Am J Emerg Med. 2000;18(6):683-686. (Prospective observational survey; 724 patients) DOI: 10.1053/ajem.2000.16312
  25. Robson MC, Duke WF, Krizek TJ. Rapid bacterial screening in the treatment of civilian wounds. J Surg Res. 1973;14(5):426-430. (Review)
  26. van den Baar MT, van der Palen J, Vroon MI, et al. Is time to closure a factor in the occurrence of infection in traumatic wounds? A prospective cohort study in a Dutch level 1 trauma centre. Emerg Med J. 2010;27(7):540-543. (Prospective study; 425 patients)
  27. Zehtabchi S, Tan A, Yadav K, et al. The impact of wound age on the infection rate of simple lacerations repaired in the emergency department. Injury. 2012;43(11):1793-1798. (Systematic review and meta-analysis; 4 studies, 3724 patients)
  28. Berk WA, Osbourne DD, Taylor DD. Evaluation of the ‘golden period’ for wound repair: 204 cases from a third world emergency department. Ann Emerg Med. 1988;17(5):496-500. (Prospective observational study; 372 patients) DOI: 10.1016/s0196-0644(88)80246-4
  29. American College of Emergency Physicians. American College of Emergency Physicians: clinical policy for the initial approach to patients presenting with penetrating extremity trauma. Ann Emerg Med. 1999;33(5):612-636. (Review)
  30. Chatterjee JS. A critical review of irrigation techniques in acute wounds. Int Wound J. 2005;2(3):258-265. (Review)
  31. Angerås MH, Brandberg A, Falk A, et al. Comparison between sterile saline and tap water for the cleaning of acute traumatic soft tissue wounds. Eur J Surg. 1992;158(6-7):347-350. (Randomized controlled trial; 705 patients)
  32. Bansal BC, Wiebe RA, Perkins SD, et al. Tap water for irrigation of lacerations. Am J Emerg Med. 2002;20(5):469-472. (Prospective study; 46 patients)
  33. Moscati RM, Mayrose J, Reardon RF, et al. A multicenter comparison of tap water versus sterile saline for wound irrigation. Acad Emerg Med. 2007;14(5):404-409. (Randomized controlled trial; 634 patients)
  34. Weiss EA, Oldham G, Lin M, et al. Water is a safe and effective alternative to sterile normal saline for wound irrigation prior to suturing: a prospective, double-blind, randomised, controlled clinical trial. ii. 2013;3(1):e001504. (Randomized controlled trial; 663 patients)
  35. Nicks BA, Ayello EA, Woo K, et al. Acute wound management: revisiting the approach to assessment, irrigation, and closure considerations. Int J Emerg Med. 2010;3(4):399-407. (Review)
  36. Wheeler CB, Rodeheaver GT, Thacker JG, et al. Side-effects of high pressure irrigation.Surg Gynecol Obstet. 1976;143(5):775-778. (Animal model study)
  37. Singer AJ, Hollander JE, Subramanian S, et al. Pressure dynamics of various irrigation techniques commonly used in the emergency department. Ann Emerg Med. 1994;24(1):36-40. (Matched experimental trial; 10 patients)
  38. Fernandez R, Griffiths R, Ussia C. Effectiveness of solutions, techniques and pressure in wound cleansing. JBI Libr Syst Rev. 2004;2(7):1-55. (Systemic review; 14 randomized controlled trials)
  39. Fry DE. Pressure irrigation of surgical incisions and traumatic wounds. Surg Infect (Larchmt). 2017;18(4):424-430. (Review)
  40. Gravett A, Sterner S, Clinton JE, et al. A trial of povidone-iodine in the prevention of infection in sutured lacerations. Ann Emerg Med. 1987;16(2):167-171. (Randomized controlled trial; 500 patients)
  41. Roberts AH, Roberts FE, Hall RI, et al. A prospective trial of prophylactic povidone iodine in lacerations of the hand. J Hand Surg Br. 1985;10(3):370-374. (Prospective study; 418 patients)
  42. Ghafouri HB, Zare M, Bazrafshan A, et al. Randomized, controlled trial of povidone-iodine to reduce simple traumatic wound infections in the emergency department. Injury. 2016;47(9):1913-1918. (Randomized controlled trial; 444 patients)
  43. Lammers RL, Fourré M, Callaham ML, et al. Effect of povidone-iodine and saline soaking on bacterial counts in acute, traumatic, contaminated wounds. Ann Emerg Med. 1990;19(6):709-714. (Randomized controlled trial; 29 patients)
  44. Dire DJ, Welsh AP. A comparison of wound irrigation solutions used in the emergency department. Ann Emerg Med. 1990;19(6):704-708. (Randomized controlled trial; 531 patients)
  45. Lee I, Agarwal RK, Lee BY, et al. Systematic review and cost analysis comparing use of chlorhexidine with use of iodine for preoperative skin antisepsis to prevent surgical site infection. Infect Control Hosp Epidemiol. 2010;31(12):1219-1229. (Meta-analysis; 9 studies, 3614 patients)
  46. Lineaweaver W, Howard R, Soucy D, et al. Topical antimicrobial toxicity. Arch Surg. 1985;120(3):267-270. (Prospective in-lab study)
  47. Brewer JD, Gonzalez AB, Baum CL, et al. Comparison of sterile vs nonsterile gloves in cutaneous surgery and common outpatient dental procedures: a systematic review and meta-analysis. JAMA Dermatol. 2016;152(9):1008-1014. (Systematic review and meta-analysis; 14 studies, 12,275 patients)
  48. Gaufberg SV, Walta MJ, Workman TP. Expanding the use of topical anesthesia in wound management: sequential layered application of topical lidocaine with epinephrine. Am J Emerg Med. 2007;25(4):379-384. (Randomized controlled trial; 100 patients)
  49. Adler AJ, Dubinisky I, Eisen J. Does the use of topical lidocaine, epinephrine, and tetracaine solution provide sufficient anesthesia for laceration repair? Acad Emerg Med. 1998;5(2):108-112. (Prospective randomized double-blind study; 60 patients)
  50. Tayeb BO, Eidelman A, Eidelman CL, et al. Topical anaesthetics for pain control during repair of dermal laceration. Cochrane Database Syst Rev. 2017;2(2):CD005364. (Meta-analysis; 25 studies, 3278 patients)
  51. Pryor GJ, Kilpatrick WR, Opp DR. Local anesthesia in minor lacerations: topical TAC vs lidocaine infiltration. Ann Emerg Med. 1980;9(11):568-571. (Randomized controlled trial; 158 patients)
  52. Ernst AA, Marvez-Valls E, Nick TG, et al. LAT (lidocaine-adrenaline-tetracaine) versus TAC (tetracaine-adrenaline-cocaine) for topical anesthesia in face and scalp lacerations. Am J Emerg Med. 1995;13(2):151-154. (Randomized controlled trial; 95 patients)
  53. Singer AJ, Stark MJ. Pretreatment of lacerations with lidocaine, epinephrine, and tetracaine at triage: a randomized double-blind trial. Acad Emerg Med. 2000;7(7):751-756. (Randomized double-blind trial; 43 patients)
  54. Singer AJ, Stark MJ. LET versus EMLA for pretreating lacerations: a randomized trial.Acad Emerg Med. 2001;8(3):223-230. (Double-blind randomized controlled trial; 60 patients)
  55. Vandamme E, Lemoyne S, van der Gucht A, et al. LAT gel for laceration repair in the emergency department: not only for children? Eur J Emerg Med. 2017;24(1):55-59. (Chart review; 89 patients)
  56. Park SW, Oh TS, Choi JW, et al. Topical EMLA Cream as a pretreatment for facial lacerations. Arch Plast Surg. 2015;42(1):28-33. (Prospective observational study; 100 patients)
  57. Swaminathan A. Local Anesthetic Systemic Toxicity (LAST). 2017. Accessed November 15, 2021. (Review)
  58. Benko K. Fixing faces painlessly: facial anesthesia in emergency medicine. Emerg Med Pract. 2009;11(12):1-20. (Review)
  59. Brogan GX Jr, Giarrusso E, Hollander JE, et al. Comparison of plain, warmed, and buffered lidocaine for anesthesia of traumatic wounds. Ann Emerg Med. 1995;26(2):121-125. (Randomized prospective single-blind study; 45 patients)
  60. Bartfield JM, Sokaris SJ, Raccio-Robak N. Local anesthesia for lacerations: pain of infiltration inside vs outside the wound. Acad Emerg Med. 1998;5(2):100-104. (Randomized prospective single-blind study; 63 patients)
  61. Hogan ME, vanderVaart S, Perampaladas K, et al. Systematic review and meta-analysis of the effect of warming local anesthetics on injection pain. Ann Emerg Med. 2011;58(1):86-98. (Systematic review and meta-analysis; 18 studies, 831 patients)
  62. Orlinsky M, Hudson C, Chan L, et al. Pain comparison of unbuffered versus buffered lidocaine in local wound infiltration. J Emerg Med. 1992;10(4):411-415. (Randomized controlled trial)
  63. Song J, Kim H, Park E, et al. Pre-emptive ice cube cryotherapy for reducing pain from local anaesthetic injections for simple lacerations: a randomised controlled trial. Emerg Med J. 2018;35(2):103-107. (Randomized controlled trial; 50 patients)
  64. Afridi RA, Masood T, Ahmed E, et al. Comparison of the efficacy of single volar subcutaneous digital block and the dorsal two injections block. J Ayub Med Coll Abbottabad. 2014;26(1):88-91. (Randomized controlled trial; 126 patients)
  65. Cannon B, Chan L, Rowlinson JS, et al. Digital anaesthesia: one injection or two? Emerg Med J. 2010;27(7):533-536. (Randomized controlled trial; 76 patients)
  66. Okur OM, Şener A, Kavakli H, et al. Two injection digital block versus single subcutaneous palmar injection block for finger lacerations. Eur J Trauma Emerg Surg. 2017;43(6):863-868. (Randomized controlled trial; 50 patients)
  67. Prabhakar H, Rath S, Kalaivani M, et al. Adrenaline with lidocaine for digital nerve blocks. Cochrane Database Syst Rev. 2015;2015(3):CD010645. (Systematic review; 4 randomized controlled trials, 167 patients)
  68. Waterbrook AL, Germann CA, Southall JC. Is epinephrine harmful when used with anesthetics for digital nerve blocks? Ann Emerg Med. 2007;50(4):472-475. (Literature review; 7 articles)
  69. Bar-Meir E, Zaslansky R, Regev E, et al. Nitrous oxide administered by the plastic surgeon for repair of facial lacerations in children in the emergency room. Plast Reconstr Surg. 2006;117(5):1571-1575. (Prospective trial; 60 patients)
  70. Lee JH, Kim K, Kim TY, et al. A randomized comparison of nitrous oxide versus intravenous ketamine for laceration repair in children. Pediatr Emerg Care. 2012;28(12):1297-1301. (Prospective randomized study; 32 patients)
  71. Abhari RE, Martins JA, Morris HL, et al. Synthetic sutures: clinical evaluation and future developments. J Biomater Appl. 2017;32(3):410-421. (Literature review; 37 studies)
  72. Xu B, Xu B, Wang L, et al. Absorbable versus nonabsorbable sutures for skin closure: a meta-analysis of randomized controlled trials. Ann Plast Surg. 2016;76(5):598-606. (Meta-analysis; 19 randomized controlled trials, 1748 patients)
  73. Gillanders SL, Anderson S, Mellon L, et al. A systematic review and meta-analysis: do absorbable or non-absorbable suture materials differ in cosmetic outcomes in patients requiring primary closure of facial wounds? J Plast Reconstr Aesthet Surg. 2018;71(12):1682-1692. (Systematic review and meta-analysis; 11 studies, 751 patients)
  74. Pourang A, Crispin MK, Clark AK, et al. Use of 5-0 fast absorbing gut versus 6-0 fast absorbing gut during cutaneous wound closure on the head and neck: a randomized evaluator-blinded split-wound comparative effectiveness trial. J Am Acad Dermatol. 2019;81(1):213-218. (Prospective nonrandomized trial; 50 patients)
  75. Hochberg J, Meyer KM, Marion MD. Suture choice and other methods of skin closure. Surg Clin North Am. 2009;89(3):627-641. (Review)
  76. Singer AJ, Quinn JV, Hollander JE. The cyanoacrylate topical skin adhesives. Am J Emerg Med. 2008;26(4):490-496. (Review)
  77. Quinn J, Wells G, Sutcliffe T, et al. Tissue adhesive versus suture wound repair at 1 year: randomized clinical trial correlating early, 3-month, and 1-year cosmetic outcome. Ann Emerg Med. 1998;32(6):645-649. (Prospective randomized trial; 136 patients)
  78. Shapiro AJ, Dinsmore RC, North JH Jr. Tensile strength of wound closure with cyanoacrylate glue. Am Surg. 2001;67(11):1113-1115. (In-lab experiment)
  79. Quinn J, Wells G, Sutcliffe T, et al. A randomized trial comparing octylcyanoacrylate tissue adhesive and sutures in the management of lacerations. JAMA. 1997;277(19):1527-1530. (Randomized controlled trial; 130 patients)
  80. Bruns TB, Worthington JM. Using tissue adhesive for wound repair: a practical guide to Dermabond. Am Fam Physician. 2000;61(5):1383-1388. (Review)
  81. Davis KP, Derlet RW. Cyanoacrylate glues for wilderness and remote travel medical care. Wilderness Environ Med. 2013;24(1):67-74. (Review)
  82. Farion K, Osmond MH, Hartling L, et al. Tissue adhesives for traumatic lacerations in children and adults. Cochrane Database Syst Rev. 2002(3):CD003326. (Meta-analysis and systematic review; 8 studies)
  83. Iavazzo C, Gkegkes ID, Vouloumanou EK, et al. Sutures versus staples for the management of surgical wounds: a meta-analysis of randomized controlled trials. Am Surg. 2011;77(9):1206-1221. (Meta-analysis; 20 studies, 2111 patients)
  84. Hollander JE, Singer AJ. Laceration management. Ann Emerg Med. 1999;34(3):356-367. (Review)
  85. Ozturk D, Sonmez BM, Altinbilek E, et al. A retrospective observational study comparing hair apposition technique, suturing and stapling for scalp lacerations. World J Emerg Surg. 2013;8:27. (Retrospective observational study; 134 patients)
  86. Karaduman S, Yürüktümen A, Güryay SM, et al. Modified hair apposition technique as the primary closure method for scalp lacerations. Am J Emerg Med. 2009;27(9):1050-1055. (Prospective study; 102 patients)
  87. Hock MO, Ooi SB, Saw SM, et al. A randomized controlled trial comparing the hair apposition technique with tissue glue to standard suturing in scalp lacerations (HAT study). Ann Emerg Med. 2002;40(1):19-26. (Randomized controlled trial; 189 patients)
  88. Ong ME, Coyle D, Lim SH, et al. Cost-effectiveness of hair apposition technique compared with standard suturing in scalp lacerations. Ann Emerg Med. 2005;46(3):237-242. (Retrospective cost analysis)
  89. Katz KH, Desciak EB, Maloney ME. The optimal application of surgical adhesive tape strips. Dermatol Surg. 1999;25(9):686-688. (Prospective study; 12 patients)
  90. Zempsky WT, Parrotti D, Grem C, et al. Randomized controlled comparison of cosmetic outcomes of simple facial lacerations closed with Steri-Strip Skin Closures or Dermabond tissue adhesive. Pediatr Emerg Care. 2004;20(8):519-524. (Randomized controlled trial; 97 patients)
  91. Davis M, Nakhdjevani A, Lidder S. Suture/Steri-Strip combination for the management of lacerations in thin-skinned individuals. J Emerg Med. 2011;40(3):322-323. (Technique description)
  92. Cummings P, Del Beccaro MA. Antibiotics to prevent infection of simple wounds: a meta-analysis of randomized studies. Am J Emerg Med. 1995;13(4):396-400. (Meta-analysis; 7 studies, 1734 patients)
  93. Moran GJ, Talan DA, Abrahamian FM. Antimicrobial prophylaxis for wounds and procedures in the emergency department. Infect Dis Clin North Am. 2008;22(1):117-143. (Review)
  94. Singer AJ, Dagum AB. Current management of acute cutaneous wounds. N Engl J Med. 2008;359(10):1037-1046. (Review)
  95. Murray CK. Field wound care: prophylactic antibiotics. Wilderness Environ Med. 2017;28(2s):S90-S102. (Review)
  96. Nakamura Y, Daya M. Use of appropriate antimicrobials in wound management. Emerg Med Clin North Am. 2007;25(1):159-176. (Review) DOI: 10.1016/j.emc.2007.01.007
  97. Medeiros I, Saconato H. Antibiotic prophylaxis for mammalian bites. Cochrane Database Syst Rev. 2001(2):CD001738. (Systematic review; 8 randomized control trials)
  98. Carver DC, Kuehn SB, Weinlein JC. Role of systemic and local antibiotics in the treatment of open fractures. Orthop Clin North Am. 2017;48(2):137-153. (Review)
  99. Kraus SJ, Eron LJ, Bottenfield GW, et al. Mupirocin cream is as effective as oral cephalexin in the treatment of secondarily infected wounds. J Fam Pract. 1998;47(6):429-433. (Randomized controlled trial; 706 patients)
  100. Heal CF, Banks JL, Lepper PD, et al. Topical antibiotics for preventing surgical site infection in wounds healing by primary intention. Cochrane Database Syst Rev. 2016;11(11):CD011426. (Meta-analysis; 14 trials, 6466 patients)
  101. Markovchick V. Suture materials and mechanical after care. Emerg Med Clin North Am. 1992;10(4):673-689. (Review)
  102. Junker JP, Kamel RA, Caterson EJ, et al. Clinical impact upon wound healing and inflammation in moist, wet, and dry environments. Adv Wound Care (New Rochelle). 2013;2(7):348-356. (Review)
  103. Toon CD, Ramamoorthy R, Davidson BR, et al. Early versus delayed dressing removal after primary closure of clean and clean-contaminated surgical wounds. Cochrane Database Syst Rev. 2013(9):CD010259. (Meta-analysis; 4 randomized controlled trials, 280 patients) DOI: 10.1002/14651858.CD010259.pub3
  104. Goldberg HM, Rosenthal SA, Nemetz JC. Effect of washing closed head and neck wounds on wound healing and infection. Am J Surg. 1981;141(3):358-359. (Randomized controlled trial; 200 patients)
  105. Hall S. A review of the effect of tap water versus normal saline on infection rates in acute traumatic wounds. J Wound Care. 2007;16(1):38-41. (Review)
  106. Toon CD, Sinha S, Davidson BR, et al. Early versus delayed post-operative bathing or showering to prevent wound complications. Cochrane Database Syst Rev. 2013(10):CD010075. (Meta-analysis; 1 trial, 857 patients)
  107. Ship AG, Weiss PR. Pigmentation after dermabrasion: an avoidable complication. Plast Reconstr Surg. 1985;75(4):528-532. (Retrospective study; 67 patients)
  108. Ardeshirpour F, Shaye DA, Hilger PA. Improving posttraumatic facial scars. Otolaryngol Clin North Am. 2013;46(5):867-881. (Review)
  109. Brown DJ, Jaffe JE, Henson JK. Advanced laceration management. Emerg Med Clin North Am. 2007;25(1):83-99. (Review)
  110. Badeau A, Lahham S, Osborn M. Management of complex facial lacerations in the emergency department. Clin Pract Cases Emerg Med. 2017;1(3):162-165. (Case report; 1 patient)
  111. Alani A. Survey of facial laceration closure in the ED: physicians’ and nurses’ choice of closure method. Am J Emerg Med. 2009;27(9):1159-1160. (Survey study)
  112. Sabatino F, Moskovitz JB. Facial wound management. Emerg Med Clin North Am. 2013;31(2):529-538. (Review) DOI: 10.1016/j.emc.2013.01.005
  113. Mattick A, Clegg G, Beattie T, et al. A randomised, controlled trial comparing a tissue adhesive (2-octylcyanoacrylate) with adhesive strips (Steristrips) for paediatric laceration repair. Emerg Med J. 2002;19(5):405-407. (Randomized controlled trial; 60 patients)
  114. Coates WC. Face and scalp lacerations. In: Tintinalli JE, Ma OJ, Yealy DM, et al, eds.Tintinalli’s Emergency Medicine: A Comprehensive Study Guide, 9th ed. McGraw-Hill Education; 2020. (Textbook chapter)
  115. Mark DG, Granquist EJ. Are prophylactic oral antibiotics indicated for the treatment of intraoral wounds? Ann Emerg Med. 2008;52(4):368-372. (Review)
  116. Karounis H, Gouin S, Eisman H, et al. A randomized, controlled trial comparing long-term cosmetic outcomes of traumatic pediatric lacerations repaired with absorbable plain gut versus nonabsorbable nylon sutures. Acad Emerg Med. 2004;11(7):730-735. (Randomized controlled trial; 95 patients)
  117. Tejani C, Sivitz AB, Rosen MD, et al. A comparison of cosmetic outcomes of lacerations on the extremities and trunk using absorbable versus nonabsorbable sutures. Acad Emerg Med. 2014;21(6):637-643. (Randomized controlled trial; 73 patients)
  118. Luck R, Tredway T, Gerard J, et al. Comparison of cosmetic outcomes of absorbable versus nonabsorbable sutures in pediatric facial lacerations. Pediatr Emerg Care. 2013;29(6):691-695. (Randomized controlled trial; 98 patients)
  119. Shetty PC, Dicksheet S, Scalea TM. Emergency department repair of hand lacerations using absorbable vicryl sutures. J Emerg Med. 1997;15(5):673-674. (Retrospective study; 102 patients)
  120. Tolins ML, Hippe DS, Morse SC, et al. Wound care follow-up from the emergency department using a mobile application: a pilot study. J Emerg Med. 2019;57(5):629-636. (Pilot study; 100 patients)

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