Resident Manual of Trauma to the Face, Head and Neck

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

1. Microdebridement y y Accomplished with sterile saline, or tap water from a clean outlet should sterile saline be unavailable, to decrease the bacterial load in tissues. y y Although several liters of saline irrigation are adequate, a 2:1 solution of saline and povidone-iodine, usually in the volume of 1.5 liters is preferable. y y A surgical scrub brush is helpful for abrasions. y y For larger wounds, a bulb syringe or intravenous tubing irrigation will suffice. y y For smaller penetrations or puncture wounds, a plastic intravenous catheter on a 20-cubic-centimeter syringe works well. y y Commercial products like Pulsavac® (Zimmer) are available for simultaneous, aggressive lavage and microdebridement of wounds. 2. Macrodebridement In cases of large particulate matter (e.g., glass or gravel) manual debridement is necessary. y y Again, pretreatment with local anesthesia is advocated. y y Prior to definitive closure, obviously devitalized soft tissue should be debrided. However, the extensive facial blood supply permits tissue survival, even in the setting of severe trauma. Therefore limited, rather than extensive, debridement of tissue deemed marginal should be attempted in most cases. D. Fundamentals of Wound Closure The surgeon must bring knowledge of suture materials, needles, and closure techniques, most of which are beyond the scope of this Resident Manual. 1. Prepare Wound The surgeon must understand differences between permanent suture (e.g., nylon, polypropylene (Prolene™)) and resorbable suture (e.g., plain gut, chromic catgut, polyglactin (910 Vicryl™)), and between monofilaments (e.g., poliglecaprone (Monocryl™)) and polyfilaments (e.g., silk). Important characteristics include time of retained tensile strength and time to resorbtion. Of particular importance for traumatic repairs, recognize the relative increased risks of infection with polyfila- ment materials secondary to bacteria harboring between individual

filament fibers. 2. Close Tissues

Following wound preparation, close tissues in a meticulous layered fashion to include periosteum, muscle, subcutaneous tissue, and skin or mucosa, as involved.

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