What is the step-by-step guide to suturing a small finger laceration on a pediatric patient?

Step-by-Step Guide to Suturing a Small Finger Laceration on a 12-Year-Old Boy

For optimal outcomes when suturing a small finger laceration in a pediatric patient, begin with topical anesthesia followed by local infiltration if needed, and use absorbable sutures to avoid the pain and anxiety of suture removal. 1

Pain Management

• Apply LET (lidocaine, epinephrine, and tetracaine) to the wound and cover with an occlusive dressing or place a cotton ball soaked with LET solution into the wound 1
• Allow LET to soak for 10-20 minutes or until wound edges appear blanched 1
• For deeper lacerations that may require supplemental anesthesia, use lidocaine injection after topical anesthesia 1
• Inject lidocaine in an almost painless manner by:
  • Buffering the anesthetic with bicarbonate
  • Warming the lidocaine before injection
  • Injecting slowly with a small-gauge needle 1

Wound Preparation

• Perform hand hygiene with antimicrobial soap or alcohol-based hand rub before touching the wound 1
• Use sterile technique including sterile gloves, gown, equipment, and sterile towels 1
• Clean the area with betadine or chlorhexidine over a large area of skin 1
• Gently irrigate the wound to remove debris and reduce infection risk 2

Laceration Repair Technique

1. Assess the wound for depth, foreign bodies, and involvement of underlying structures 2
2. For a small finger laceration:
   • Reapproximate subcutaneous tissues if needed using absorbable sutures 3
   • Use the smallest gauge suture appropriate for the location (typically 5-0 or 6-0 for fingers) 2
   • Place simple interrupted sutures approximately 2-3mm apart 2
   • Consider using absorbable sutures to avoid the pain and anxiety of suture removal, especially in pediatric patients 1

Special Considerations for Pediatric Patients

• Consider using tissue adhesives (such as octyl cyanoacrylate) for low-tension wounds as they provide essentially painless closure 1
• Steri-Strips may provide similar painless closure and are less expensive than tissue adhesives 1
• For children who are anxious or uncooperative, consider:
  • Distraction techniques and guided imagery 1
  • Parental presence during the procedure 4
  • Age-appropriate games or videos on electronic devices 1

Infection Prevention

• Maintain sterile technique throughout the procedure 1
• Be aware that infection rates in pediatric lacerations are generally lower than in adults, but larger lacerations (>3 cm) and those on lower extremities have higher infection rates 5
• Consider prophylactic antibiotics only if the wound is heavily contaminated or involves high-risk structures 3

Post-Procedure Care

• Apply a light, sterile dressing to protect the wound 2
• Provide clear instructions to parents about wound care:
  • Keep the wound clean and dry for 24-48 hours
  • Watch for signs of infection (increasing pain, redness, swelling, or discharge) 3
  • Pain control can be achieved with acetaminophen, ibuprofen, and ice packs 3
• Schedule follow-up if needed, particularly for wounds at high risk of infection or complications 3

Pitfalls to Avoid

• Never use substantial force when injecting local anesthesia as this increases pain 1
• Avoid using plain saline for topical anesthesia as studies show it is ineffective in reducing injection pain 6
• Do not use petroleum-based hand lotions before donning gloves as petroleum can deteriorate latex material 1
• Remember that children under 6 years of age (particularly those under 6 months) may be at greatest risk of adverse events during procedures requiring sedation 1

By following these steps, you can effectively repair a small finger laceration in a pediatric patient while minimizing pain and anxiety and achieving optimal cosmetic and functional outcomes.