7 year old laceration in heel. OPD prescription
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I now have enough information to write a clear OPD prescription for a 7-year-old with a heel (plantar/posterior heel) laceration.
OPD Prescription - Heel Laceration (7-Year-Old)
Patient: Child, 7 years old
Diagnosis: Laceration - Heel (Plantar/Posterior)
Date: 08/07/2026
Procedure Done at OPD
- Wound irrigation - copious normal saline wash
- Local anesthesia - Lignocaine 2% plain (without adrenaline on plantar surface)
- Wound closure - Absorbable suture (Vicryl 3-0 / Monocryl 3-0) for deep layer if needed; Non-absorbable monofilament (Prolene/Nylon 3-0 or 4-0) for skin - placed as vertical mattress sutures (to achieve eversion on the thick plantar/heel dermis)
- Note: Adhesive tapes, tissue glue, and staples are NOT used on the plantar/heel surface
Medicines Prescribed
| # | Drug | Dose | Route | Frequency | Duration |
|---|---|---|---|---|---|
| 1 | Tab. Amoxicillin-Clavulanate (Augmentin 228.5 mg susp. or 312.5 mg tab) | 20-25 mg/kg/day | Oral | BD | 5 days |
| 2 | Tab. Paracetamol (Calpol/Crocin) | 15 mg/kg/dose (approx. 250-325 mg) | Oral | TDS (every 8 hrs, as needed for pain) | 3-5 days |
| 3 | Povidone-Iodine 5% ointment (Betadine) | Apply thin layer | Local | BD dressing | 5-7 days |
| 4 | Tetanus Toxoid (DTaP) | 0.5 mL | IM (deltoid) | Single dose | - |
For tetanus: If the child has received < 3 doses of DTP/DTaP, or immunization history is unknown - give DTaP + Tetanus Immune Globulin (TIG 250 units IM, different site). If fully immunized (3+ doses) and last dose within 5 years - no booster needed. If last dose >5 years ago - give DTaP booster.
Dressing Instructions
- Keep the wound dry for 24-48 hours
- Dressing change every 24-48 hours at home or clinic
- Apply povidone-iodine ointment, cover with non-adherent gauze (Mepore/Melolin), secure with crepe bandage
- Do NOT walk barefoot - padded footwear recommended
- Elevate the limb when resting to reduce swelling
Follow-Up
- Review in 3-5 days for wound check and dressing
- Suture removal at 10-14 days (heel skin heals slower due to weight-bearing and tension)
- Return immediately if: fever, increasing redness/swelling, pus discharge, or wound gaping
Red Flags - Advise Parents to Attend ER if:
- Wound reopens or deepens
- Suspicion of tendon or bone involvement (unable to move foot/toes normally)
- Signs of infection: fever >38.5°C, wound hot/red/swollen
Notes:
- Since the patient is a child, monofilament absorbable sutures (Monocryl) may be preferred for the skin closure to avoid a distressing suture removal visit (per Tintinalli's EM guidelines for children).
- Ensure the child is placed prone with the foot overhanging the cart during repair for good access to the heel.
- A heel pad or donut dressing post-closure helps offload pressure on the wound.
Sources: Tintinalli's Emergency Medicine (9th ed.), Rosen's Emergency Medicine (9th ed.) - wound management and tetanus prophylaxis protocols
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