The management of soft tissue facial wounds

The physiological and physical principles involved in the management of facial lacerations are reviewed. Because there have been no previously published descriptions of the actual problems encountered in clinical practice in A & E Departments, a prospective clinical survey of 100 consecutive patients with facial lacerations repaired by oral & maxillofacial house surgeons was undertaken and a series of lacerations was studied in detail. These included periorbital, nasal, labial and neck injuries. High magnification revealed irregularity of wound margins in almost all cases, frequent localised ischaemia, necrosis, localised dehiscence and infection or inadequate closure. Because all of these problems are likely to increase scarring and deformity, this study suggests the need for a re-appraisal of the management of facial lacerations, particularly in relation to local skin edge excision, prevention of infection, and the use of magnification during closure.