Traumatic wounds in MaxFac
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Short notes on the classification and managements of traumatic wounds in the maxillofacial area (soft tissue)
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Traumatic wounds in MaxFac
- 1. S Management of traumatic wounds in maxillofacial area
- 2. Introduction S The face is vital to human appearance and function. S Disfiguring facial injuries can have severe psychological and social consequences.
- 3. Etiology S Injuries range from superficial abrasions to avulsion & nearby specialized structure. S Sports S Motor vehicle collisions S Interpersonal and domestic violence. S Falls, animal bites, and recreational activities S Gunshot wounds and other explosive or incendiary devices
- 4. Etiology S Abrasions S Contusions S Lacerations S Avulsions S Bites S Gunshots
- 5. Anatomy S Bone S Nerves S Vasculature S Glands S Muscle S Skin
- 6. Managment S Prehospital management: S Airway S Bleeding
- 7. EXAMINATION S History S Breathing S Speaking S Vision S Hearing S Numbess S Teeth
- 8. EXAMINATION S Scalp S Eyes S Ear S Nose S Mouth and lips S Parotid and lacrimal ducts S Nerves
- 9. Pharmacologic Therapy S Antibiotics: S bite? S contamination S Tetanus S Anesthetics: S Lidocaine
- 10. Surgical Repair S Cleaning and debridement S Normal saline S Healthy edges S Adequately apposed edges
- 11. Suturing S Sutures choice: S Functional S Esthetic S Patient S Non-dissolvable suture >> less scar? S Layered Suturing S Minimize tension S Close spaces S Restore function
- 12. Suturing
- 13. Suturing S Non-linear wounds S Stellate-like
- 14. Abrasion S cleansed w/ soap solution S Irrigated w/ normal saline S Remove all foreign material to avoid ’tattooing’ S Covered with a thin layer of topical antibiotic ointment S Reepithelialization in 7-10 days
- 15. Contusion S Small hematomas resolve w/o treatment S Hypo / hyper pigmentation can occur rarely permanent S Large hematomas should be drained prevent permanent
- 16. Lacerations S Principal : hemostasis & avoid dead space S Layered technique closure S margin beveled / ragged ) to prevent scar formation S Z-plasty if necessary S Pressure dressing
- 17. Avulsions S Small areas : local undermining, followed w/ primary closure S If not possible : local flaps, or skin graft S Delayed primary closure effective when extensive soft tissue trauma present
- 18. Bites S Aggressive Irrigation w/ normal saline S debridement S Antibiotic prophylaxis - < 24 hrs : pasteurella multocida amoxicillin / clavulanate - > 24 hrs : streptococcus / staphylococcus penicillin resistant ab S Primary closure S Rabies prophylaxis as indication
- 19. Gun Shots S Hemostasis & stabilization ( ABC..) S Immediate definitive reconstruction : S carefully debride unsalvageable soft tissue S preserve & replace viable displace soft tissue to its anatomic location
- 20. Lip S 1-mm discrepancies of the vermillion border are noticeable at conversational distance S Orbicularis muscle S Rapid absorbing suture
- 21. Trap door laceration S bulging within the flap. S minimized by approximation of the subcutaneous tissue to the base of the flap
- 22. Nose S Damage to lateral or septal cartilages S Disruption of the nasal cartilage should be realigned by repairing the overlying tissue while avoiding direct suturing of the cartilage. S alar margins S guide wound repair and alignment
- 23. Cheek S Parotid Injury? S Clear discharge S Catheter in duct S Nerve S Repair within 72 hrs
- 24. Tongue S Large lacerations (>1 cm in length) S Deep lacerations on the lateral border of the tongue S Large flaps or gaps in the tongue S Lacerations with significant hemorrhage S Lacerations that may cause dysfunction if improper healing occurs (anterior split tongue)
- 25. After Care S Facial wounds benefit from a moist environment with nonadhesive dressings S Coverage with an antibiotic ointment an nonadherent gauze S Dressings can be secured with paper or micropore tape to minimize further skin irritation. S Wounds in areas covered with hair (eyebrow, heard, mustache) can be treated with antibiotic ointment alone. S After 24 to 48 hours, wounds closed with nonabsorbable sutures can be left open to air and cleansed gently with soap and water.