A laceration (cut) is a wound by a sharp or dull object. Depending on the sharpness of the object the edges may be jagged, dirty, or bleeding. Lacerations may occur anywhere on the body but obviously when they occur on the face the long-term cosmetic result is of considerable importance. Lacerations most often affect the skin, but any tissue may be lacerated, including subcutaneous fat, tendon, nerves, blood vessels and muscle.

WHEN TO REPAIR?
A facial laceration should have an evaluation by an emergency room physician, a primary care physician or a plastic surgeon to determine the best approach for treatment. A facial laceration should be repaired if any one of these applies:

• It continues to bleed after application of pressure for ten to fifteen minutes
• It is deep enough to expose the underlying tissue (fat, muscle, tendon, or bone)
• It causes a change in function surrounding the area of the laceration
• It is dirty or has visible debris occurs
• It is in an area near vital structures (nose, mouth, eyes, ears)

HOW SOON SHOULD REPAIR OCCUR?
Lacerations are less likely to become infected if they are repaired soon after they occur thus prompt evaluation by a physician is recommended. The face is unique because it has very good circulation. This good circulation can somewhat reduce the risk of infection thus the can be closed temporarily if the complexity of the laceration requires a plastic surgeon. The plastic surgeon can then definitely close the laceration in 2-3 days. Many physicians will not repair a laceration in other areas of the body that is more than eight hours old because the risk of infection is too great (poorer circulation).

FACIAL LACERATION TREATMENT
The main goals of treatment are to stop any bleeding, prevent infection, preserve function, and restore appearance.

Before repairing the laceration, Dr. Stephenson anesthetizes the laceration by administering a local anesthetic. The local anesthetic provides patient comfort while the physician thoroughly examines the wound and the underlying tissue. Removing any foreign material or debris cleans the laceration. The laceration is irrigated with saline (saltwater) solution. The area of the laceration is prepared for closure by applying a disinfecting agent.

Once the wound has been cleansed, severely damaged tissues, if present, will be removed. Several sutures are placed in the tissue under the skin to help bring the tissue layers together so that the skin can be correctly aligned. The skin is closed with sutures. A light dressing or an adhesive bandage is applied for 24-48 hours. If the laceration is the result of a human or animal bite, if it is very dirty, or if the patient has a medical condition that alters wound healing, oral antibiotics may be prescribed.

FACIAL LACERATION RECOVERY
The laceration is kept clean and dry for at least 24 hours after the repair. Light bathing is generally permitted after 48 hours if the wound is not soaked. There may be mild to moderate swelling and bruising that occurs after the repair. The swelling and bruising usually subsides in about 7 days but this varies between patients. Sutures are removed 5-7 days depending on complexity and location of the wound.

The repaired area is cleansed twice a day with a Hydrogen Peroxide/water mixture a Q-tip. This is followed by application of a “thin” layer of Bacitracin ointment to the area for 3-4 days. Be extra careful around the eyes.

The repair should be observed twice a day for signs of infection, which include redness, swelling, tenderness, drainage from the wound, red streaks in the skin surrounding the repair, chills, or fever. If any of these occur, Dr. Stephenson should be contacted immediately.

During the early healing period the scar will be pink. During this stage the scar is very vulnerable to sun. Sun exposure even during cloudy days will eventually result in permanent darkening of the scar therefore to prevent this darkening and to make sure that the scar is least noticeable application of a sunscreen is recommended after the sutures are removed. A sunscreen (SPF 30 or higher) is generally recommended. Apply sunscreen until the scar matures (pink color goes away). The pink color may stay up to 6-12 month. Application of sunscreen should be part of everyone’s daily routine as an aid in the prevention of sun damage and the development of skin cancer.

All lacerations will heal with a scar. Wounds that are repaired with sutures are less likely to develop scars that are unsightly, but no one can predict how wounds will heal and who will develop unsightly scars.

FACIAL LACERATION REPAIR CREDENTIALS
Credentials matter. Dr. Stephenson is a clinical professor of Surgery at the Atlanta Medical Center where he trains surgical residents on all aspects of plastic surgery including the management and treatment of major maxillofacial trauma. The Atlanta Medical is one of Atlanta’s major trauma centers. Dr. Stephenson is board certified in two important surgical specialties for facial fracture repair facial reconstruction and facial cosmetic surgery. His certifications include the American Board of Oral & Maxillofacial Surgery and the American Board of Plastic Surgery.

Dr. Stephenson will be happy to any questions pertaining to facial fractures or any aspect of plastic surgery. To obtain more information call Signature Plastic Surgery (770) 466-4700.