The Case: 5 year-old otherwise healthy girl presenting with 1 cm facial laceration occurring 29 hours prior to visit.

Here’s how you responded:

Discussion: The case generated a good amount of discussion. As Dr. Lindgren mentioned in the post, very little evidence exists for this topic (Cochrane Review, Quinn et al). In this setting, Dr. Pershad highlighted the importance of shared decision making with the patient and the family (scar vs risk of infection). The other issue that came up in the discussion was the concern of having to debride the wound (in essence creating a new injury) and this potentially being outside the scope of PEM practice. Ultimately, the decision to perform a delayed primary closure will depend on provider comfort, discussion with the family, and availability for close outpatient follow-up. For those of you who want to read more on the subject, here is another FOAM post on the subject written by an adult EM physician at Kaiser.

Denouement: Unfortunately, patient returned in the next 24 hours with marked erythema and swelling of the wound and diagnosed with a wound infection. She was admitted for IV antibiotics and will be scheduled for plastic surgery follow-up for possible scar revision.

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