Resident Manual of Trauma to the Face, Head and Neck

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

3. Closure by Secondary Intent Closure by secondary intent is permissible, wherein both patient (or surrogate) and surgeon participate in good wound care and allow for slow but steady closure of the defect. It should be considered in cases of uncontrolled diabetes, chronic hypoxia due to cardiopulmonary disease, or any other significant wound-healing deficit. 4. Adjunctive Therapies Adjunctive therapies, such as the implementation of wound-healing factors or devices or the use of hyperbaric oxygen, may also be required. 5. Post-Healing After the wound is healed, the scar can be dealt with appropriately. B. Anesthesia Considerations Adults and children deemed sufficiently compliant can often undergo closure using injectable local anesthesia alone. The anesthesiologist should counsel parents or caretakers regarding the steps required, and give them factual information in an honest but empathetic manner. Ideally, regional nerve blocks (i.e., infraorbital, mental, supratrochlear, and supraorbital) should be performed to achieve excellent wide-field anesthesia and minimize tissue distortion that results from subcutane- ous permeation of significant fluid volume (Figure 9.1). Once the blocks have taken effect, local infiltration with a limited volume should be administered for targeted local anesthesia and hemostasis. 1 1. Localized Tissue Injuries a. Injectable Local Anesthesia

Figure 9.1 A 10-year-old female with stellate right medial brow laceration. Supraorbital and supratrochlear blockade provides excellent anesthesia for wound irrigation and closure in the clinic setting. Closure must address realignment of the eyebrow.

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