Objective To explore the application of plastic cosmetic debridement and suture in emergency pediatric facial trauma surgery and its influence on wound scar formation. Methods Totally 450 children with facial trauma admitted to the First Affiliated Hospital of Xinjiang Medical University from January to December 2023 were selected as the research subjects, and they were divided into control group and study group according to the random number table method, with 225 children in each group. The control group was treated with routine suture measures, and the study group was treated with plastic cosmetic debridement and suture. The clinical efficacy, knot reaction, wound scar formation and postoperative adverse event rate were compared between the two groups. Results The total effective rate of treatment in the study group was 97.78%, which was higher than 76.44% in the control group (P <0.05). The proportion of 0 degree knot reaction in the study group was 88.00%, which was higher than 36.44% in the control group (P <0.05). The proportions of Ⅰ degree knot reaction, Ⅱ degree knot reaction and Ⅲ degree knot reaction in the study group were 10.22%, 1.78% and 0 respectively, which was lower than 28.89%, 20.00% and 14.67% in the control group (P <0.05). The scar assessment scale score in the study group was lower than that in the control group (P <0.05). The incidence of postoperative adverse events in the study group was 0.89%, which was lower than 7.11% in the control group (P <0.05). Conclusion The application of plastic and cosmetic debridement suture in emergency pediatric facial trauma surgery is effective, which can reduce the suture reaction and improve the wound healing scar. It has high safety and good clinical application value.