214 / 242
Resident Manual of Trauma to the Face, Head, and Neck
212
Chapter 9: Soft Tissue Injuries of the Face, Head, and Neck
y
y
Ensure a secure airway. Keep in mind that swelling and subsequent
airway compromise may present in a delayed fashion.
y
y
The breadth of wounding will present in a delayed fashion. Therefore,
do not remove, or repair, tissue acutely until all wound margins have
declared themselves in the days following the injury (Figure 9.6).
y
y
For thermal and electrical injuries, use soft tissue cooling to minimize
perpetual tissue injury.
y
y
When caustic or chemical agents are suspected, copiously irrigate
wounds to dilute the offending agent.
y
y
Administer antibiotics to cover skin flora and pseudomonal species.
y
y
Keep wounds moist at all times.
1. Facial Subsites
Many facial subsites, including the external auditory canal, eyelids,
nares, and mouth, are at great risk for retraction, contraction, and
stenosis. Definitive management cannot begin until tissue viability has
been declared, and may require skin grafting, local soft tissue rear-
rangements, stents, or other adjunctive procedures and devices.
Figure 9.6
A 2-year-old who bit into a refrigerator electric cord. Suffered third-degree burn with
vaporization of central lower lip tissues and first-degree burns to upper lip, gingiva, and
anterior tongue. Wound managed conservatively to allow demarcation of tissue viability.
Minimal tissue debridement performed and lip closed on post-injury day 7.