(4) Irrigate wound with sterile saline to remove exudate and debris.

(5) Topical agents may be used if the wound is colonized, infected, or at risk of being infected.

Routine use of antiseptic solutions is not recommended because most solutions destroy granulation tissue.

i. Silver sulfadiazine cream is contraindicated

in infants less than 30 days of age because

the sulphonamides increase the risk of kernicterus. In addition, the cream can obscure

the wound by forming a difficult to remove

opaque layer.

ii. Use of povidone–iodine is not recommended because absorption of iodine may

suppress thyroid function.

iii. Antibacterial creams and ointments have

limited roles.

(6) Wound dressing

i. The selection of dressing material depends

on the depth of the wound, the property of

the wound bed (presence of granulation tissue, moist, dry, exudative) (19).

ii. Wet wounds require absorptive dressing,

whereas dry wounds benefit from hydrating

dressings.

iii. Amorphous hydrogels consisting of carboxymethylcellulose polymer, propylene glycol,

and water have been shown to keep the

wound moist and facilitate wound healing

(13,19). They are available in the form of

gels or sheets, which may be applied directly

to the wound surface and held in place

by a secondary dressing. The gel is easily

removed with saline and is generally

changed every 3 days. More frequent dressing changes may be required if there is excessive exudation.

iv. Silver-impregnated dressings are postulated

to decrease wound infection (20).

v. Alginate dressings are fibers derived from

brown seaweed and useful for wounds with

moderate to heavy exudates (19).

vi. Polyurethane foams are also useful for

wounds with exudates.

(7) If the scar involves a flexion crease, passive rangeof-motion exercises with each diaper change

may help to prevent contractures.

(8) Plastic surgical consultation

a. Recommended for all full-thickness and

significant partial-thickness extravasation

injuries

b. Enzymatic or surgical débridement or skin

grafting may be required (3,21–24).