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Chapter 9: Soft Tissue Injuries of the Face, Head, and Neck
3. Closure by Secondary Intent
Closure by secondary intent is permissible, wherein both patient (or
surrogate) and surgeon participate in good wound care and allow for
slow but steady closure of the defect. It should be considered in cases
of uncontrolled diabetes, chronic hypoxia due to cardiopulmonary
disease, or any other significant wound-healing deficit.
4. Adjunctive Therapies
Adjunctive therapies, such as the implementation of wound-healing
factors or devices or the use of hyperbaric oxygen, may also be
required.
5. Post-Healing
After the wound is healed, the scar can be dealt with appropriately.
B. Anesthesia Considerations
1. Localized Tissue Injuries
a. Injectable Local Anesthesia
Adults and children deemed sufficiently compliant can often undergo
closure using injectable local anesthesia alone. The anesthesiologist
should counsel parents or caretakers regarding the steps required, and
give them factual information in an honest but empathetic manner.
Ideally, regional nerve blocks (i.e., infraorbital, mental, supratrochlear,
and supraorbital) should be performed to achieve excellent wide-field
anesthesia and minimize tissue distortion that results from subcutane-
ous permeation of significant fluid volume (Figure 9.1). Once the blocks
have taken effect, local infiltration with a limited volume should be
administered for targeted local anesthesia and hemostasis.
1
Figure 9.1
A 10-year-old female with stellate right medial brow laceration. Supraorbital and
supratrochlear blockade provides excellent anesthesia for wound irrigation and
closure in the clinic setting. Closure must address realignment of the eyebrow.