Postoperative Care of the Facial Laceration

Abstract

The purpose of this investigation is to examine factors involved in the postoperative care of traumatic lacerations. An evidence-based comprehensive literature review was conducted. There are a limited number of scientifically proven studies that guide surgeons and emergency room physicians on postoperative care. Randomized controlled trials must be conducted to further standardize the postoperative protocol for simple facial lacerations.KEYWORDS: Laceration, wound closure, postoperative careThe management of facial lacerations is common for surgeons who take trauma call at their local hospitals and for emergency room physicians. In fact, we have more calls to the emergency rooms for treatment of soft tissue injuries at our hospitals than we do for bony injuries. Because of the visibility of the face, it should not be surprising that much attention has been given to the technique(s) for the closure of traumatic facial lacerations. Studies are plentiful that evaluate a host of factors, such as methods of cleansing and debridement, types of sutures, layered versus nonlayered closure, use of adhesives rather than sutures, and so on. There is a paucity of information, however, about what to do after the laceration has been closed. Most texts on the management of facial injuries mention very little regarding this topic.Most of the aftercare recommended for facial lacerations seems to be based upon the varied opinions of the individual surgeon rather than on scientific factors. In fact, there seems to be no consensus, and often what is recommended by one surgeon is castigated by another.The purpose of this article is to examine the factors involved in postoperative care of traumatic lacerations. We have tried to identify the most scientific information available to make treatment recommendations, but it should be realized that good evidence for much of what is currently being done is not based on science, and just as importantly, there is not much science on this topic to guide the clinician. Although we are discussing the treatment of traumatic facial lacerations, much of the studies that are available have been performed on lacerations elsewhere in the body. However, there is no reason to believe that they aren't applicable the facial region. The information presented here should also apply to incisions made on the face for any reason. SURGICAL TAPESurgical tape to reinforce sutured lacerations at the time of closure and after suture removal is often used as adjunctive wound care. Surgical tape theoretically minimizes skin tension. In a cadaveric study, the reinforcement of surgical tape with mastisol over a sutured skin incision exhibited a slightly higher strength against separating forces when compared with sutures alone,

Analysis of Patients with Facial Lacerations Repaired in the Emergency Room of a Provincial Hospital

“…Sometimes stitches were removed at 4 days after primary repair when wound healing was rapid, for example, for simple wounds in eyelids. According to one report, surgical adhesive strip may provide some benefits for up to 6 weeks postoperatively [ 10 ]. However, the duration of its use is highly dependent on convenience and patient compliance, and thus, after total stitch-out, we applied surgical adhesive strip for 2 weeks to amenable sites to prevent hypertrophic scarring.…”

Analysis and management of pathogens isolated from patients with complicated facial lacerations and abrasions

“… 11 Staphylococcus epidermidis is one of the most common bacteria found in the resident skin flora. 14 Therefore, when Staphylococcus epidermidis was isolated, it was often regarded as a contaminant and not a true pathogen. 13 It plays an important role in preventing pathogenic colonisation of the skin by producing anti‐microbial peptides.…”

“…Several studies have stated that the routine use of antibiotics is not essential in patients with facial lacerations and abrasions because of low infection rates (less than 5%) 3 , 5 , 14 However, we recommend the use of oral and/or systemic antibiotics in patients with complicated wounds, because these wounds are likely to be infected. 3 Cephalexin and netilmicin were used for coverage against gram‐positive and gram‐negative bacteria, respectively, and additional antibiotics were administered according to the results of antimicrobial susceptibility testing.…”

“…In addition to covering wounds, they help in wound healing by creating a wet environment. 14 , 15 The dressing used most commonly in this study before culture results were obtained was foam dressing using Mepilex Lite (59.62%), followed by Cutimed Sorbact gel dressing (26.92%) and Bactigras (Smith and Nephew, Romford, Essex, UK; 10.58%). Cutimed Sorbact gel dressing was the most commonly used dressing after culture results were obtained (81.73%), followed by foam dressing (16.35%).…”

Soft Tissue Management in Facial Trauma

“…Systemic antibiotics should be considered in specific cases such as bite wounds, puncture wounds, the presence of foreign bodies, heavy contamination, jagged wound edges, delayed closure, and in patients who are immunocompromised or at high risk for adverse outcomes. 16…”