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Objective: The purpose of this study was to compare cosmesis at 3 to 4 months and infection in simple lacerations irrigated with normal saline (NS) versus activated chlorine dioxide (CD)., Design: This was a prospective, randomized trial of a convenience sample of patients. This study was approved by the institutional review board and Food and Drug Administration as a physician-sponsored trial (FDA investigational new drug no. 68762)., Setting: The study was conducted in a large urban, academic emergency department., Patients: Patients aged 18 to 100 with simple, uncomplicated lacerations requiring repair that were less than 8 hours old were enrolled., Interventions: Patients were randomized to receive either NS or CD wound irrigation., Main Outcome Measures: Demographics, infection, and cosmesis were analyzed and assessed. Cosmetic outcome was assessed at 3 to 4 months using a visual analog scale (VAS), wound evaluation score (WES), patient VAS (VASPt), and digital imaging VAS by 2 plastic surgeons (VASPlast)., Main Results: One hundred ninety-three patients were enrolled. Data analysis was available for 175 cases (86 NS and 89 CD). Wound infection follow-up was obtained in 74.9% of the patients. The 3- to 4-month cosmesis follow-up was 37.7% for VAS/WES, 40.0% for VASPt, and 37.7% for VASPlast. There were no significant differences in demographics, key wound characteristics, infection, adverse reactions, and cosmesis., Conclusion: The authors report the use of a novel antimicrobial irrigation solution. Chlorine dioxide appears to be a safe biologically acceptable antiseptic wound irrigant that does not appear to interfere with cosmetic outcomes.

Objective: Aesthetic outcome is an important end point of wound care. The purpose of this study was to compare a wound aesthetic scoring system by emergency physicians, patients, and digital imaging by blinded plastic surgeons. The goal was to see if digital photography could accurately analyze the aesthetics of closed lacerations for future research., Methods: This was a subanalysis of a prospective, randomized trial conducted in an urban, academic emergency department. Patients aged 18 to 100 years were included if they had simple, uncomplicated lacerations 8 hours old or less located on the trunk, head or neck (not scalp), or extremities that required repair by sutures. Exclusion criteria included immunocompromised state of health, a complicated laceration, specialty consultant intervention in management of the wound, or current use of or need for antibiotics for wound prophylaxis. Complicated lacerations were defined in the article. Infection outcomes, demographics, and aesthetic outcomes were assessed. Scar appearance was assessed at 3 to 4 months after closure using a previously validated 0-to 100-mm visual analog scale (VAS) score and 6-point wound evaluation score (WES) done by 2 trained emergency physicians (MD1 and MD2). Patients also performed self-VAS (VAS(Pt)), whereas VAS was done using digital imaging by 2 trained plastic surgeons (VAS(Plast1) and VAS(Plast2)). Data were evaluated when both plastic surgeons independently believed that the digital images were able to be adequately scored. Pearson correlation coefficients were performed using mean values., Results: Three- to 4-month VAS(MD) and WES(MD) follow-up was obtained in 66 of 175 (37.7%), 3- to 4-month VAS(Pt) follow-up was obtained in 70 of 175 (40.0%), and 3- to 4-month digital imaging assessment was obtained in 66 of 175 (37.7%). Digital images were evaluated for VAS(Plast) in 34 of 66 (51.5%). Mean scores for VAS(MD1) and VAS(MD2) were 84.2 (SD, 12.4) mm and 87.8 (SD, 10.5) mm. Mean scores for WES(MD1) and WES(MD2) were 5.5 (SD, 1.0) and 5.4 (SD, 1.0). Mean scores for VAS(Pt) were 86.6 (SD, 16.6) mm. Mean scores for VAS(Plast1) and VAS(Plast2) were 78.7 (SD, 26.6) mm and 66.2 (SD, 30.2) mm. Moderate correlation was noted for VAS(MD1) and VAS(MD2) (r = 0.63; n = 34; P < .001), WES(MD1) and WES(MD2) (r = 0.70; n = 34; P < .001), and VAS(Plast1) and VAS(Plast2) (r = 0.74; n = 34; P < .001). Correlations were also moderate for VAS(MD) and VAS(Plast) (r = 0.56; n = 34; P < .001), VAS(Pt) and WES(MD) (r =0.60; n = 34; P < .001), and VAS(MD) and WES(MD) (r = 0.64; n = 34; P < .001). However, correlations were weak for VAS(Pt) and VAS(Plast) at r = 0.25 (n = 34; P = .16), VAS(Pt) and VAS(MD) at r = 0.37 (n = 34; P =.03), and WES(MD) and VAS(Plast) at r = 0.13 (n = 34; P =.45). Three- to 4-month VAS(MD) and WES(MD) follow-up was obtained in 66 of 175 (37.7%), 3- to 4-month VAS(Pt) follow-up was obtained in 70 of 175 (40.0%), and 3- to 4-month digital imaging assessment was obtained in 66 of 175 (37.7%). Digital images were evaluated for VAS(Plast) in 34 of 66 (51.5%). Mean scores for VAS(MD1) and VAS(MD2) were 84.2 (SD, 12.4) mm and 87.8 (SD, 10.5) mm. Mean scores for WES(MD1) and WES(MD2) were 5.5 (SD, 1.0) and 5.4 (SD, 1.0). Mean scores for VAS(Pt) were 86.6 (SD, 16.6) mm. Mean scores for VAS(Plast1) and VAS(Plast2) were 78.7 (SD, 26.6) mm and 66.2 (SD, 30.2) mm. Moderate correlation was noted for VAS(MD1) and VAS(MD2) (r = 0.63; n = 34; P < .001), WES(MD1) and WES(MD2) (r = 0.70; n = 34; P < .001), and VAS(Plast1) and VAS(Plast2) (r = 0.74; n = 34; P < .001). Correlations were also moderate for VAS(MD) and VAS(Plast) (r = 0.56; n = 34; P < .001), VAS(Pt) and WES(MD) (r = 0.60; n = 34; P < .001), and VAS(MD) and WES(MD) (r = 0.64; n = 34; P < .001). However, correlations were weak for VAS(Pt) and VAS(Plast) at r = 0.25 (n = 34; P = .16), VAS(Pt) and VAS(MD) at r = 0.37 (n = 34; P =.03), and WES(MD) and VAS(Plast) at r = 0.13 (n = 34; P =.45).Three-to 4-month VAS(MD) and WES(MD) follow-up was obtained in 66 of 175 (37.7%), 3- to 4-month VAS(Pt) follow-up was obtained in 70 of 175 (40.0%), and 3- to 4-month digital imaging assessment was obtained in 66 of 175 (37.7%). Digital images were evaluated for VAS(Plast) in 34 of 66 (51.5%). Mean scores for VAS(MD1) and VAS(MD2) were 84.2 (SD, 12.4) mm and 87.8 (SD, 10.5) mm. Mean scores for WES(MD1) and WES(MD2) were 5.5 (SD, 1.0) and 5.4 (SD, 1.0). Mean scores for VAS(Pt) were 86.6 (SD, 16.6) mm. Mean scores for VAS(Plast1) and VAS(Plast2) were 78.7 (SD, 26.6) mm and 66.2 (SD, 30.2) mm. Moderate correlation was noted for VAS(MD1) and VAS(MD2) (r = 0.63; n = 34; P < .001), WES(MD1) and WES(MD2) (r = 0.70; n = 34; P < .001), and VAS(Plast1) and VAS(Plast2) (r = 0.74; n = 34; P < .001). Correlations were also moderate for VAS(MD) and VAS(Plast) (r = 0.56; n = 34; P < .001), VAS(Pt) and WES(MD) (r = 0.60; n = 34; P < .001), and VAS(MD) and WES(MD) (r = 0.64; n = 34; P < .001). However, correlations were weak for VAS(Pt) and VAS(Plast) at r = 0.25 (n = 34; P = .16), VAS(Pt) and VAS(MD) at r = 0.37 (n = 34; P =.03), and WES(MD) and VAS(Plast) at r = 0.13 (n = 34; P =.45)., Conclusions: Correlations were moderate for VAS(MD) and VAS(Plast); however, correlations were weak for VAS(Pt) and VAS(Plast), VAS(Pt) and VAS(MD), and WES(MD) and VAS(Plast). This small study assessing digital imaging as a tool for evaluating scar aesthetics demonstrated limitations in its use. Future studies with larger populations and improved imaging modalities, such as 3-dimensional cameras and high-dynamic-range imaging, may provide potential for better assessment.