Facial Lacerations

Question 1

What factors of laceration will affect subsequent tx?

Answer 1

Size - length and depth
Tissue loss
Involvement of important structures
Degree contamination and presence foriegn bodies

Question 2

Why is it important to look at degree of tissue loss?

Answer 2

To see if can stretch skin to achieve primary closure and not distort tissue

Question 3

What are options for laceration if insufficient tissue for primary closure?

Answer 3

Heal w/ secondary intention
Rotation of skin flap
Skin graft

Question 4

How to confirm presence of foreign objects in wound

Answer 4

Soft tissue radiograph

Question 5

Should take verbal or written consent for laceration closure?

Answer 5

Only need written consent for tx under GA

Question 6

What would steps be for closing laceration near lip?

Answer 6

Mark the edge of the vermillion border
LA - infiltrate (consider mental block)
Disinfect wound - aqueous CHX/ iodine
Close deep structures w/ absorbable sutures
Close skin w/ non-absorbable fine sutures

Question 7

When can non-resorbable sutures be removed on facial laceration?

Answer 7

5-7 days

Question 8

What post-op advice to give to pt w/ facial laceration?

Answer 8

Keep area dry for 48 hours
Avoid make-up, coloured or scented products while healing
For most lacerations ab not required

Question 9

If laceration caused by dog bite, is there difference in mx?

Answer 9

Ensure thorough irrigation w/ saline
Prophylaxis ab - common in co-amoxiclav (625mg 3x day 7 days)

Question 10

What is first line ab for lacerations/ skin infection and its dose?

Answer 10

Co-amoxiclav
625mg TDS 7 days