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Resident Manual of Trauma to the Face, Head, and Neck

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Chapter 9: Soft Tissue Injuries of the Face, Head, and Neck

Close mucosal surfaces with 4-0 or 5-0 resorbable suture (i.e.,

chromic gut or Vicryl™), with simple interrupted, running, or run-

locking stitches.

f. Drains and Dressings

If a large dead space exists, or if an avulsed flap is replaced, it may be

necessary to place a small drain, with or without suction. Should

suction not be utilized, place the drain exit near the most dependent

portion of the wound if possible. A compressive dressing may also be

utilized for such injuries.

g. Undermining and Debridement

Occasionally, undermining with a scalpel or sharp tissue scissors in the

subdermal plane may be warranted, along with debridement, if neces-

sary. This may aid in freshening the skin edges and facilitate skin

eversion. This is particularly true in cases of beveled or scythed wounds,

or when the wound has been open for an extended period and has

begun to dry. In such cases, the wound edges begin to retract and round

themselves, and thicken from resulting edema.

3. Avoid Undertaking Local Flaps in the “Primary” Setting

Finally, any thought to undertaking local flaps in the “primary” setting

should be abolished with very limited exceptions. Excision or significant

rearrangement of potentially viable tissue may preclude further options

later, once injuries have “declared” themselves and final reconstruction

is attempted.

IV. Informed Consent

As with any emergency, there are instances where consent is implied

and treatment may commence without discussing all aspects of soft

tissue repair with the patient. However, every attempt should be made

to keep patients and their families informed throughout the process.

Remain honest, yet judicious, in disclosing potential outcomes. Set

appropriate expectations for present and future care, while also

acknowledging the stress of traumatic events. In cases where patients

and families are overwhelmed and unable to discuss or comprehend the

breadth of care required, focus their attention on the immediate

situation.

Consent should involve discussion of the planned repair itself, but also

of the potential complications and future outcomes. These include (but

are not limited to) infection, wound breakdown and tissue loss, scarring,