Anesthesia and Wound Closure for Repair

Pre-Procedure Preparation

For children, consider topical anesthetics like lidocaine, epinephrine, and tetracaine applied 10-20 minutes before procedure, as recommended by the American Academy of Pediatrics 1
Ensure adequate anesthesia (regional or general) for proper pain control during repair, and prepare the wound site with appropriate antiseptic solution (povidone-iodine or chlorhexidine if iodine allergic) 2
The American Academy of Dermatology suggests considering nerve block anesthesia for facial procedures as it may provide better anesthesia with less tissue distortion than infiltrative anesthesia 3

Monofilament sutures (5-0 or 6-0) are recommended for skin closure due to less bacterial seeding, reduced infection risk, and minimal tissue reaction, as stated in various guidelines 4, 2
Triclosan-coated sutures can be considered in high-infection-risk scenarios, as they significantly reduce surgical site infection prevalence, according to the American College of Surgeons 5
Triclosan-coated Vicryl may be beneficial in higher-infection risk scenarios for deep tissue closure, according to the American College of Surgeons 5
Rapidly absorbing synthetic sutures are recommended for perineal repairs due to elimination of the need for removal visits, as suggested by the American College of Obstetricians and Gynecologists 2
Catgut sutures are associated with more pain and higher risk of requiring resuturing 2
Close deep tissue layers with continuous non-locking sutures to distribute tension evenly 2
Continuous subcuticular closure is recommended to minimize pain and improve cosmetic outcome 2
Continuous non-locking suturing technique is recommended as it distributes tension more evenly across the suture length, reduces pain (RR, 0.76; 95% CI, 0.66-0.88), and decreases need for analgesia (RR, 0.70; 95% CI, 0.59-0.84) and suture removal (RR, 0.56; 95% CI, 0.32-0.98) 2

For small, low-tension lacerations, tissue adhesives (octylcyanoacrylate) or Steri-Strips can be considered, with studies showing comparable cosmetic outcomes between tissue adhesives and sutures in low-tension areas 6
First and second-degree tears may be managed with no suturing or skin adhesive if hemostatic, which is associated with less pain and similar functional outcomes, as recommended by the American College of Obstetricians and Gynecologists 2

Immobilization in functional position to protect repair, pain management with appropriate analgesics, and monitor for hematoma formation 2
Begin gentle range of motion exercises as tissue healing permits, and implement stretching exercises to prevent contracture formation 2
Applying Steri-Strips for additional support for 3-5 days after suture removal can be considered 6
Proper tension is critical to prevent tissue necrosis and poor healing, and suture removal timing is important, typically 5-7 days for facial sutures, although the exact timing may vary depending on the individual case 4, 6