The use of existing lacerations
1. Principles
General considerations
Frequently, patients with facial fractures also have lacerations. Very often, these existing soft-tissue injuries can be used to directly access the facial bones for management of the fractures.
The surgeon may elect to extend the laceration to provide adequate access to the fractured area, following the relaxed skin tension lines (RSTL).
Bacterial contamination is not a contraindication for the use of existing lacerations for surgical approach.
The image shows the initial laceration.
Extended laceration.
Neurovascular structures
Depending on the location of the laceration, different neurovascular structures may be affected by the injury.
For example in the illustrated case, the facial nerve is directly involved. The facial nerve can either be repaired primarily or tagged for ease of location during a secondary repair.
2. Wound closure
Wound closure for this incision is primary closure of the laceration. Proper cleansing, debridement, and hemostasis should be accomplished prior to closure.
The laceration is closed in layers with short-term resorbable interrupted sutures, realigning the anatomic structures and eliminating dead space:
- Periosteum
- Mimic muscles
- Platysma/SMAS
- Subcutaneous tissues
Damaged facial and trigeminal nerve branches are repaired as well as an injured Stensen’s duct.
A variety of skin closure techniques are available based on surgical preference. A drain may be used if necessary.
3. Example of a large facial laceration with underlying fracture
This image shows an example of soft-tissue laceration.
Elevating the soft-tissue flap reveals the underlying mandibular fracture.
