Resident Manual of Trauma to the Face, Head and Neck

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

y y 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,

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