61.1 The general method for lesser face injuries

The appearance of a wound is nowhere more important than on a patient’s face. He is unlikely to be able to consult a plastic surgeon later, so your main task is to minimize his disfigurement. This mostly means a careful toilet and accurate repair with numerous fine sutures. Plastic surgeons have few skills which you don’t have for the immediate care of a face wound—their remarkable achievements are mostly the result of careful attention to detail. So, handle a patient’s tissues gently, and be prepared to take enough time. Don’t operate on his face with equipment designed for abdominal or orthopaedic surgery, or apply artery forceps to the skin edges; use skin hooks. Your scissors should be sharp. The face has an excellent blood supply, and heals well, so: (1) Save all injured tissue that might survive. (2) Make immediate primary suture the rule in all except late or severely contaminated wounds.

The common errors are: (1) Not removing all dirt, and so leaving an area of tatooed scarring. (2) A scar with unnecessarily gross suture marks. (3) Failure to replace the wound edges in the correct position, especially those which involve the edges of the eyelids, eyebrows, lips, or nose, like that in A, Fig. 61-2.