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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
3. Dressings
While nonadherent dressings may assist with moisturization and
provide a barrier for additional contamination during the initial days
following closure, more limited injuries where meticulous wound care is
anticipated may be left uncovered.
In instances of large avulsion injuries or where significant dead space
may be present, compressive dressings should be considered.
4. Bathing
While patients should be instructed to avoid soaking in a bathtub or
pool for at least 10–14 days (or until all wounds have epithelialized),
showering with gentle soap and water is encouraged after 24–48 hours.
5. Antibiotics
For grossly contaminated wounds, parenteral or oral antibiotic prophy-
laxis is routinely implemented; however, with minor and reasonably
clean wounds, antibiotic use may be declined.
6. Nutrition
Adequate nutrition—often a challenge in polytrauma or burn patients,
specifically—remains critical.
7. Head Elevation
Elevation of the head may alleviate swelling.
8. Patient and Caretaker Instructions
Signs and symptoms that may indicate developing infection should
always be explained at great length to patients and caretakers (assis-
tance with handouts is encouraged in this regard).
9. Suture Removal
Suture removal is generally considered after 5–7 days on the face and
7–10 days on the neck or scalp. Staples placed in the scalp should be
removed after 10–14 days.
10. Hypertrophic Scarring and Hyperemia
Hypertrophic scarring and hyperemia are more likely to occur with
traumatic injuries, especially in children, and can be lessened by
application of silicone gel applied twice daily for up to 2 months after
initial wound healing. Initiate this therapy 2–4 weeks after repair,
depending on healing.