Lacerations

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Definition

-  Type of wound with seperation of connective tissue components of skin +/- with jagged edges

 

Features

-  Usually caused by blunt trauma

-  Should usually be closed within 6hrs of injury for optimum healing

 

Types

-  Facial lacerations

 

Mx

-  Wound repair

 

 

 

Facial Lacerations

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Features

-  Laceration type of wound to face

 

Features

-  Primary closure preferred method as results in least noticeable scar

-  Because of laxity of facial skin most wounds can be primarly repaired unless significant tissue loss or swelling

-  Excellent blood supply to face

-  Wounds can be closed > 6hrs post injury +/- day after if still able to be cleaned

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Procedure

-  See Wound Repair w additional comments below

-  Wound Cleaning

-  Minimal edge debridement

-  Ensure when cleaning & irrigating wound eyes are protected from solution to prevent damage

-   Tegederm/opsite over eye

-  Anaesthetic

-  LA into wound edges if small OR if large or on lip use nerve block

-   Mental nerve block: lower lip, skin inferior to lip

-   Infraorbital nerve block: upper lip, lateral nose, lower eyelid, medial cheeck

-   Supraorbital/supratrochelar nerve block: forehead

-  Avoid adrenaline with LA when suturing flaps

-  Suture choice

-  Nylon preffered material

-  Absorbable should be used for mucosa ie: lips

-  Suture placement should be approx 3mm apart, 1-2mm from skin edge to achieve best tissue approximation

-  If skin edges easily aligned can use either continuous or interrupted

-  Irregular lacerations of wounds at risk of infection use interrupted

-   If infected single sutures can be removed to inspect/drain wound

-  Suture removal 5 to 7 days to reduce scarring

-  Wound care

-  Antibiotic ointment to suture line

-  Dry gauze

-  Clean 1-2 times per day with gentle soap & water

-  Shower as usual day post repair

-  After cleaning use antibiotic ointment

-  Avoid heavy lifting & bending to prevent facial swelling

 

 

 

 

Lip Laceration

-  Vermillion border must be aligned meticulously to avoid irregularity

-  Nerve block to explore, clean & repair

 

 

 

Reference

 

Practical Plastic Surgery for Nonsurgeons: Chapter 16 – Facial Lacerations