Facial injuries can occur in motor vehicle accidents, household accidents, sports injuries, animal attacks, and physical violence. Most of the facial injuries involve the skin only. However, in more severe cases, structures such as the eye, nose, lips, ears, and even the facial bones may also be affected. In the most severe scenario, the brain and upper airway may be traumatized with dangerous, life-threatening consequences.
Apart from its various functional roles, the face also serves important aesthetic functions as well. Facial injuries invariably produce scars, defects, and deformities to the face that are easily noticeable. Besides affecting the patient physically, there are also profound psychologic effects on the patient, significantly affecting the patient’s occupation and social functions.
Classification of Facial Wounds
Incised wounds: An incised wound is a clean-cut wound caused by sharp objects such as a knife or broken glass. Treatment is by proper wound cleansing and surgical closure.
Lacerations: Lacerations are jagged tears that go all the way through the skin. The cause is blunt trauma to the skin. There may be associated with tissue loss. It is essential to clean the wound, remove debris and dead tissues, and do proper surgical closure. Scarring is usually more abundant and subsequent scar management is usually required.
Abrasions: An type of open wound that’s caused by the skin rubbing against a rough surface, in which the superficial layer of the skin scraped off. It is crucial to clean the wound properly and remove debris from the wound. Antibiotic ointment is applied to prevent infection and maintain moisture. Abrasions usually will not cause scarring, but post-inflammatory hyperpigmentation may occur.
Puncture Wounds: Caused by an object puncturing the skin, such as a splinter, nail, needle, or pencil tip. Bleeding is usually minimal, but the wounds are typically deep, and there is a risk of infection. It is essential to clean the wound thoroughly and remove any embedded foreign body or debris.
Avulsions: A condition where the skin or body structure detaches forcefully from its normal point of insertion. Avulsion wounds in the face may involve the nose, eyelid, ear, or even a sizeable facial skin or scalp area. The wounds should be cleaned and debrided and followed by tissue reattachment and reconstruction.
Management of Facial Injuries
Patients with facial injuries wish to restore their faces as much as possible to the original look. Thus, repairing facial injuries would require detailed knowledge of the facial anatomy, close attention to the details, and masterful surgical skills to achieve the best possible aesthetic and functional results.
Management of facial injury is highly individual. It depends on the patient’s general condition, the severity of the facial injury, and other injuries in other parts of the body. Minor facial injuries usually can be repaired under local anaesthesia in the clinic setting. For more severe cases involving an unstable patient with multiple injuries, it is best to manage the patient in the hospital. In such a scenario, the priority is to stabilize the patient before carrying out wound repair and other treatments.
Wash the wound with saline solution, stop bleeding, and remove all debris, foreign bodies, and devitalized tissues. It is crucial to close the wound as soon as possible. Early wound closure within 6 hours lowers the risk of infection, reduce wound complications, and improves subsequent aesthetic results.
In facial injuries, suturing is done to close the wounds. The surgeon approaches the damaged tissues with great care, realign each tissue layer correctly before closing the wound. Alternatives to sutures are skin staples for hair-bearing areas, adhesive tape, and skin glue for small injuries. Adhesive tape and skin glue may be the fastest, easiest, and most cost-effective way to close a clean, minor wound in children or uncooperative patients. It is possible to repair small cuts under local anaesthesia. However, children may require sedation if they cannot stay still during wound closure.
Antibiotic ointment is used to prevent infection and keeps the wound moist. Systemic antibiotics are generally not required in clean, superficial wounds that have been adequately washed and cleaned. However, it may be necessary to use systemic antibiotics in specific cases such as bite wounds, puncture wounds, heavy contamination, jagged wound edges, delayed closure, and in patients who are diabetic or immunocompromised.
Patients with facial injuries usually present soon after the trauma for immediate treatment and repair. However, some patients had injuries some time ago but later come to the surgeon because of problematic scars or residual deformities. These cases would require detailed assessment and proper treatment with scar treatment and tissue restoration.