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Twin Cuts Chin .......advice wanted


tonyman

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last Saturday evening we took all 5 to the park and the 5 yr old twin falls off the monkey bars and landed on a metal platform where he cut open his chin , a deep gash and lots of blood , took him to the late night medial centre where they "glued" it , a first for me as ive always dealt with stitches . We took the dressing off tonight and to our horror the wound is still wide open ! I cleaned it the best I could and re dressed it and told mrs tonyman I will take him to our surgery in the morning for stitches not glue . so to any nurses out there ,am I doing the right thing , will he need sedating while having stitches (he has had them in his head before) and can you tell me why they would have glued such a wide wound on a child that is bound to mess with the dressing at some point , thanks

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It won't be stitchable after a week Nick...best thing is to get him to a clinic without delay. Does it look clean, no ooze or redness? Glue normally works well for minor wounds and they like to use it on kids, my daughter had a head wound glued in the uk...Im not an ed nurse though or a childrens nurse so sure there'll be some better advice than what I can give. It needs closing though asap to make sure the scar is minimal..have you got any paper stitches in a first aid kit? You lay them on one side of the wound and stretch them over to close it neatly without puckering the skin...they often put them on after theyve glued it for extra strength...poor lad:(

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There is a slightly higher risk that glued wounds will reopen, so its usually used for simple wounds with straight edges. It's been a few years since I worked in A/E but I would say it won't be stitched after a week. I'd get him there first thing Nick x

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thanks girls but why cant it be stitched after a week ? if they glue it again , what is stopping it from re opening .....I will be at my GP`s first thing ....it did look pretty clean , no smell and I gave it a cotton bud wash around the cut ect .........

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What Happy Heart said :yes:. In the meantime, you could get those little "butterfly" dressings to keep the edges of the wound as close as possible. Keep the wound clean and dry, watch for redness, oozing, fever - if you see any of those, go to ER. My little one had her chin glued when she fell on it, these head wounds bleed a lot but glue was fine in her case. Get your boy to see the doc as soon as possible. Good luck to your boy :hug:

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What Happy Heart said :yes:. In the meantime, you could get those little "butterfly" dressings to keep the edges of the wound as close as possible. Keep the wound clean and dry, watch for redness, oozing, fever - if you see any of those, go to ER. My little one had her chin glued when she fell on it, these head wounds bleed a lot but glue was fine in her case. Get your boy to see the doc as soon as possible. Good luck to your boy :hug:

 

Marsuka , I will be on the phone at 8 am to my GP and nurse , they may say send him to A and E .....because of the sedative if he needs one but he is pretty tough ........its not good though that a nurse can glue a cut and say give it a week and take off the dressing ....? and what do you get another open wound !!!!!

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Marsuka , I will be on the phone at 8 am to my GP and nurse , they may say send him to A and E .....because of the sedative if he needs one but he is pretty tough ........its not good though that a nurse can glue a cut and say give it a week and take off the dressing ....? and what do you get another open wound !!!!!

 

 

I don`t think this is A&E case anymore, your GP should refer you to plastic surgeon to see your son and recommend what should be done. If he needs stitches, he might be OK with local anesthesia at this age. If not, he might get a sedation, it doesn`t have to be IV, it can be a syrup. It wears off in about 4 hours. If you think he will do OK without sedation, don`t let the medical staff talk you into it for their convenience. I`ve found out ( at work and with my son) that a lot of times it just needs patience and communication, 5 year old can understand a lot . My son`s dentist wanted to sedate Adam for a tiny filling - it was seen only on X ray and they are only fixing it because he needs a kind of a brace and it might get worse. I am glad I was stubborn and told them to try without sedation, he did great and was done in 5 minutes!

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ok , my GP said after 6 hours stiches can not be used , he said to leave the wound open and a course of antibiotics plus a repeat will do the trick ....came home and he banged his head big style on door frame ,tom n jerry lump , he is one accident prone lad .....also has a big rope burn behind his ear, must be off the trampoline ............

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You seem to have the chin wound addressed now. As an NP working in ED I see lots of children with lacerations. As a rule I give parents and if appropriate the patient all the facts, and let them choose. This is my take on the situation:

All wounds heal. How important is the scar?

Any wound with lateral stress will open with glue, eg across the chin (side to side, rather than along (up and down)

SteriSterips or LeukoStrips do not reduce risk

Wounds can be closed up to 12 hours post injury, after that failure to heal risk, and infection is high

All wounds should be irrigated to reduce risk of infection

All wounds more than 12 hours old need oral antibiotics

Tetanus still kills, your child should be immunized

A well prepared child that has supportive parents in a quiet environment, with time can usually be sutured with topical Laceraine for an hour followed by a 30g needle for infiltration with lignocaine

Frightened children need sedation after fasting for 6 hours

Tears, screaming and restraint are never acceptable. That is a failure of the clinician

There is no evidence for antibiotic creams on the wound after closure

 

Hope this helps

 

Chris

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ok , my GP said after 6 hours stiches can not be used , he said to leave the wound open and a course of antibiotics plus a repeat will do the trick ....came home and he banged his head big style on door frame ,tom n jerry lump , he is one accident prone lad .....also has a big rope burn behind his ear, must be off the trampoline ............

 

but I have to add , he is one happy happy lad , he is a comedian .........Thanks ChrisH1 , the injury is healing so well , he has not scratched / picked at it at all and the medication has done its job .......something I never knew about until last weekend ..........thanks to all involved in this thread .......

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