Primary closure of maxillo-facial wounds

In maxillo-facial wounds with soft tissue involvement, the most important object in the initial treatment is to secure primary closure without deformity, or, if that is not possible, primary epithelialisation of the raw surfaces. In addition to the early healing with minimal scar tissue which results, this allows further operative procedures to be carried out much earlier and under much simpler conditions than if healing had occurred by granulation and scarring. The operative technique adopted in a series of 304 patients in a maxillo-facial surgical unit in the BLA included meticulous toilet and excision of wound surfaces before closure by several different methods: when soft tissue loss was minimal, direct closure in layers was affected; when the soft tissue defect was too large for direct closure the wound was closed by either local flaps or skin to mucous membrane suture or skin grafting of the raw surface. Examples of these methods are shown. In a series of 165 cases in whom the immediate results have been personally observed or on whom reports have been received, 153 cases (93 per cent) have been completely successful, 10 cases (6 per cent) have had a partial breakdown of the wound, and two cases (1.2 per cent) have been complete failures.