Resident Manual of Trauma to the Face, Head and Neck

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

3. Dressings While nonadherent dressings may assist with moisturization and provide a barrier for additional contamination during the initial days following closure, more limited injuries where meticulous wound care is anticipated may be left uncovered. In instances of large avulsion injuries or where significant dead space may be present, compressive dressings should be considered. 4. Bathing While patients should be instructed to avoid soaking in a bathtub or pool for at least 10–14 days (or until all wounds have epithelialized), showering with gentle soap and water is encouraged after 24–48 hours. 5. Antibiotics For grossly contaminated wounds, parenteral or oral antibiotic prophy- laxis is routinely implemented; however, with minor and reasonably clean wounds, antibiotic use may be declined. 6. Nutrition Adequate nutrition—often a challenge in polytrauma or burn patients, specifically—remains critical. 7. Head Elevation Elevation of the head may alleviate swelling. 8. Patient and Caretaker Instructions Signs and symptoms that may indicate developing infection should always be explained at great length to patients and caretakers (assis- tance with handouts is encouraged in this regard). 9. Suture Removal Suture removal is generally considered after 5–7 days on the face and 7–10 days on the neck or scalp. Staples placed in the scalp should be removed after 10–14 days. 10. Hypertrophic Scarring and Hyperemia Hypertrophic scarring and hyperemia are more likely to occur with traumatic injuries, especially in children, and can be lessened by application of silicone gel applied twice daily for up to 2 months after initial wound healing. Initiate this therapy 2–4 weeks after repair, depending on healing.

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