Cleaning of wounds involves copious irrigation with saline, frequently 1-2 L depending on wound size and degree of contamination. After appropriate attention to more critical injuries, wounds should be thoroughly cleaned and assessed. Underlying bony injuries to the face, cervical spine, or skull as well as intracranial injuries should be ruled out by proper exam and imaging when indicated. Physical exam as in all traumas should start with focus on the ABCs (Airway, Breathing, Circulation) and should then include a general head and neck physical exam avoiding the pitfall of concentrating on obvious or “distracting” injuries at the neglect of being thorough. Common mistakes to avoid during laceration repair are inadequate irrigation of wounds, failure to meticulously remove foreign debris, inadequate exam of wound extent especially in puncture wounds, wound closure under tension, and assumption of missing tissue in widely gaping or macerated lacerations.Īlways begin with detailed history important considerations include injury timing, any loss of consciousness, mechanism of injury, and social context (domestic abuse and assault are common causes of facial trauma making documentation especially important from a medicolegal standpoint). Antibiotics are not routinely prescribed for head and neck lacerations but should be considered in immunosuppressed patients, in ear or nasal lacerations with exposed cartilage, any open fracture, through and through lip lacerations or any laceration crossing mucosal barriers, and grossly contaminated wounds or bite wounds. While typically ordered by the Emergency Department provider, always ensure tetanus and rabies vaccinations are given when indicated. General principles of facial laceration and avulsion repair include detailed physical exam for additional injuries and damaged critical structures (e.g., facial nerve, salivary ducts, etc.), copious irrigation and cleaning of wounds, minimal tissue debridement or removal in the acute period, and closure as soon as possible after injury (i.e., at least within 24 hours for grossly non-contaminated wounds).
The care of head and neck soft tissue wounds including lacerations, avulsions, and abrasions is a crucial skill for the Otolaryngology resident to maximize functional and aesthetic outcomes. Link to instructional video on suture technique.
0 kommentar(er)
