Resident Manual of Trauma to the Face, Head and Neck

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

8. Cartilage Banking Cartilage is then banked in a subfascial or submuscular pocket over the mastoid or temporoparietal scalp. Consider banking on the contralateral side if possible to ensure adequate blood supply and distance the tissue from possible local infection. This will also minimize incisions and temporoparietal fascia violation that may be needed at the time of staged reconstruction. 9. Total and Near-Total Auricular Avulsion For total and near-total auricular avulsion, microvascular reanastomosis is advocated but depends on surgical experience and resources available. D. Periorbita 1. Ophthalmology Consultation Emphasis must be on preservation of vision and the integrity of the occular structures. Therefore, all perioccular injuries obligate an ophthalmology consultation. 2. Irrigation If occular debris or chemical exposure is suspected, copious irrigation is mandatory. 3. Delayed Closure in Operating Room Depending on the experience of the surgeon and resources available, delay in closure may be warranted to allow for experienced assistance and specialized instrumentation. In this case, closure in the operating room is ideal. Tarsorrhaphy, Frost sutures with bolsters, or an eye patch may be necessary to provide temporary protection of the cornea and globe. Remember to apply moisture in the form of basic salt solution or ophthalmic lubricating or antibiotic ointment. Use corneal protectors if necessary. 4. Lid Laceration In the event of lid laceration, repair each lamella independently. 5. Posterior Lamella Lacerations Posterior lamella lacerations may only require tarsal plate repair. Use soft, resorbable suture, like Vicryl™. Place knots superficially. Deep, inverted knots, even if covered by palpebral conjunctiva, often lead to corneal irritation and even abrasion during the blink mechanism.

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