Facial Lacerations & Bites
MANAGEMENT OF SKIN WOUNDS IN ED
All wounds must be treated almost identically; these are the key steps:
1. Obtain consent from the patient, verbally and written whenever possible
2. Explain that scars are possible to occur especially in extensive injuries
3. Set up a tray with all the instruments and disinfective solutions.
4. Infiltrate areas with a local anaesthetic agent; avoid the use of epinephrine in areas where cartilage is affected or exposed.
5. Wash, scrub and disinfect the wounds removing all the debris and make sure the wounds have sufficient blood supply. Take a good time doing this, as this is probably the key step.
6. Explore the wounds; don’t be afraid to place your finger inside extensive wounds, as this is a key element to find underlying injuries.
7. Control any profuse bleed and perform haemostasis.
8. Suturing of wounds most be done now taking in consideration the different layers: muscle, subcutaneous tissue, and skin.
- Sutures must be placed in symmetrical pattern
- Nods should be placed to one side of the incision and not on top.
- Do not overdo the number of sutures; just make sure enough are placed to ensure a sealed wound and no gaps between edges are present.
9. Skin staples are an option in non-aesthetic areas (scalp, and back of the neck).
10. Give one last cleaning to the wound gently.
11. Dry the wounds with absorbent gauze.
12. Place an antiseptic or antibiotic ointment across the wound.
13. Place a non-adherent dressing.
Postoperative instructions must be given and these should include:
Keep the wound clean and dry for 1 week
Skin sutures most be removed in 7 days (no later)
Take analgesia if required
Apply cold packs if swelling or bruising occurs
Do not pick at scabs
Use the ointment prescribed and take antibiotics as directed.
Avoid direct sun exposure to wounds.
Simple wounds will not require to be reviewed by the OMFS team again. The following are the criteria for a follow-up appointment:
High risk infection wounds (human and animal bites)
Cosmetic deformities or extensive tissue loss
Injuries requiring further reconstruction or grafts
Author: Arie Yuffa
Last updated: 22/02/15