Resident Manual of Trauma to the Face, Head and Neck

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

y y In the event of tissue loss or undue wound tension, open wounds of both the forehead and the temple heal well by second intention (Figure 9.2).

Figure 9.2 A 2-year-old ejected from motor vehicle. Large surface area of right temple and forehead with soft tissue loss and inadequate tissue volume for primary closure. Temporalis fascia and muscle provide excellent wound bed for healing by second intent. Once the wound is healed and free of infection, further scar revision, tissue expansion, and/or grafting can be done in a controlled setting. C. Auricle Appropriate wound closure requires knowledge of both the topographi- cal anatomy of the pinna and cartilage’s dependency on its perichon- drial blood supply. 1. Superficial Lacerations Superficial lacerations can be closed primarily with skin-only sutures. The absence of subcutaneous tissue on the lateral surface and the adherence of tissue to the cartilage framework make subdermal sutures impractical and unnecessary. 2. Cartilage Lacerations Cartilage lacerations should be reapproximated with monofilament, resorbable suture. Monocryl™ is an ideal material. Auricular cartilage is brittle and prone to fracture. Reverse cutting needles should be used to ensure clean entry and exit from the

198

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