Resident Manual of Trauma to the Face, Head and Neck

intervention, it is better to treat the patient in the operating room initially. B. Immediate Primary versus Delayed Closure of Contaminated Soft Tissue Wounds 1. Risk of Infection PRO primary closure —Because of the “privileged” vascular supply to the face, scalp, and neck, the likelihood is high that primary closure of contaminated wounds, after appropriate cleansing, will be successful. CON primary closure —It is risky to close a contaminated wound primar- ily, due to the risk of methicillin-resistant Staphylococcus aureus (MRSA) and other infectious agents. It is better to clean the wound over 2–3 days and then close it in a delayed fashion. 2. Cost Considerations PRO primary closure —Considerations in this controversy include the cost of early discharge after primary closure. CON primary closure —There is risk of more expensive readmission and intensive care if infection occurs. 3. Use of Metal Alloy or Resorbable Fixation Plates PRO metal alloy plates —Metal alloy fixation plates reduce the risk of mobility at tension fracture sites and the risk for nonunion. CON metal alloy plates —Metal alloy plates are more thermal conductive than the absorbable plates and may require removal for discomfort. PRO resorbable fixation plates —Resorbable fixation plates reduce stress shielding over time at tension fracture sites. CON resorbable fixation plates —Most resorbable fixation plates are higher profile, and thus more palpable, than the metal alloy fixation plates. III. Final Considerations These examples are provided to emphasize that trauma care decisions and options by otolaryngologist–head and neck surgeons have variation across the United States, occurring within the general framework of clinical guidelines, best practices, and best evidence. Your attending faculty may have a practice protocol or philosophy, based on good scientific principles, that varies somewhat from the general recommen- dations contained in this Resident Manual. Yet, the information we

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