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Chapter 9: Soft Tissue Injuries of the Face, Head, and Neck
8. Cartilage Banking
Cartilage is then banked in a subfascial or submuscular pocket over the
mastoid or temporoparietal scalp. Consider banking on the contralateral
side if possible to ensure adequate blood supply and distance the tissue
from possible local infection. This will also minimize incisions and
temporoparietal fascia violation that may be needed at the time of
staged reconstruction.
9. Total and Near-Total Auricular Avulsion
For total and near-total auricular avulsion, microvascular reanastomosis
is advocated but depends on surgical experience and resources
available.
D. Periorbita
1. Ophthalmology Consultation
Emphasis must be on preservation of vision and the integrity of the
occular structures. Therefore, all perioccular injuries obligate an
ophthalmology consultation.
2. Irrigation
If occular debris or chemical exposure is suspected, copious irrigation is
mandatory.
3. Delayed Closure in Operating Room
Depending on the experience of the surgeon and resources available,
delay in closure may be warranted to allow for experienced assistance
and specialized instrumentation. In this case, closure in the operating
room is ideal. Tarsorrhaphy, Frost sutures with bolsters, or an eye patch
may be necessary to provide temporary protection of the cornea and
globe. Remember to apply moisture in the form of basic salt solution or
ophthalmic lubricating or antibiotic ointment. Use corneal protectors if
necessary.
4. Lid Laceration
In the event of lid laceration, repair each lamella independently.
5. Posterior Lamella Lacerations
Posterior lamella lacerations may only require tarsal plate repair. Use
soft, resorbable suture, like Vicryl™. Place knots superficially. Deep,
inverted knots, even if covered by palpebral conjunctiva, often lead to
corneal irritation and even abrasion during the blink mechanism.