Assessment and management of facial lacerations
- Judd E Hollander, MD
Judd E Hollander, MD
- Professor and Vice Chair Department of Emergency Medicine
- Thomas Jefferson University
- Martin Camacho, APRN, ACNP-BC, ENP-BC
Martin Camacho, APRN, ACNP-BC, ENP-BC
- Clinical Operations Manager
- Department of Emergency Medicine
- Acute Care/Emergency Nurse Practitioner
- Hawaii Emergency Physicians Associated
- Wahiawa General Hospital
- Section Editors
- Anne M Stack, MD
Anne M Stack, MD
- Section Editor — Pediatric Procedures
- Associate Professor, Department of Pediatrics
- Harvard Medical School
- Allan B Wolfson, MD
Allan B Wolfson, MD
- Section Editor — Adult Procedures
- Professor of Emergency Medicine
- University of Pittsburgh
- Deputy Editor
- James F Wiley, II, MD, MPH
James F Wiley, II, MD, MPH
- Senior Deputy Editor — UpToDate
- Deputy Editor — Adult and Pediatric Emergency Medicine
- Deputy Editor — Primary Care Sports Medicine (Adolescents and Adults)
- Clinical Professor of Pediatrics and Emergency Medicine/Traumatology
- University of Connecticut School of Medicine
Facial lacerations warrant a detailed and meticulous approach to evaluation due to their cosmetic importance. Patients are often concerned and disconcerted about the potential for scarring from facial lacerations [1-5]. While the majority of emergency care providers are adept at the repair of facial lacerations, the technical nature of a repair related to the underlying anatomy and normal function may occasionally warrant a specialized consultation.
As with all lacerations, a proper evaluation and exploration of the wound is essential. Prior to closure, the clinician should perform an overall trauma assessment, and identify any adjacent bony injuries and disrupted anatomy (especially muscle laceration or neurovascular compromise) or involvement of specialized structures (eg, eyes, teeth). Wound débridement, cleansing, and closure are facilitated by local anesthesia, regional nerve block, or procedural sedation, depending upon the size and complexity of the laceration.
The assessment and management of facial lacerations will be reviewed here. Minor wound management, methods of suture placement, and repair of adjacent anatomic sites are discussed in detail separately:
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- Physical examination
- Diagnostic imaging
- INDICATIONS FOR SUBSPECIALTY CONSULTATION OR REFERRAL
- WOUND REPAIR
- Indications for primary closure
- Contraindications and precautions
- - Anesthesia and analgesia
- Local anesthesia
- Facial nerve blocks
- Procedural sedation
- - Wound debridement and cleansing
- - Equipment
- Suture selection
- - Simple interrupted suture placement
- - Tissue adhesives
- - Staples
- - Adhesive tapes
- - Combination of adhesives and adhesive tape
- WOUND SPECIFIC CONSIDERATIONS
- Intra-oral mucosal
- OTHER CONSIDERATIONS
- Tetanus prophylaxis
- Prophylactic antibiotics
- Bite wounds
- SOCIETY GUIDELINE LINKS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS