What is the management of facial lacerations?

From the Guidelines

Facial laceration management should prioritize prompt cleaning, assessment, and appropriate closure to minimize scarring and infection, with primary wound closure recommended for facial wounds with copious irrigation, cautious debridement, and preemptive antibiotics 1. When managing facial lacerations, it is essential to control bleeding with direct pressure, then clean the wound thoroughly with normal saline or mild soap and water.

• Assess the wound for depth, involvement of underlying structures, and foreign bodies.
• For simple lacerations, close with appropriate suture material within 24 hours of injury - typically 6-0 nylon for facial wounds.
• Apply antibiotic ointment (such as bacitracin) and cover with a non-adherent dressing.
• Remove sutures in 3-5 days for facial wounds to minimize scarring.
• Tetanus prophylaxis should be administered if the patient's immunization status is outdated or unknown.
• Prescribe oral antibiotics (such as cephalexin 500mg four times daily for 5-7 days) only for contaminated wounds, immunocompromised patients, or wounds at high risk of infection, as supported by the Infectious Diseases Society of America guidelines 1. Facial lacerations require special attention due to cosmetic concerns and the rich blood supply of the face, which promotes healing but also increases bleeding.
• Wounds crossing tension lines or involving anatomical landmarks like the vermilion border or eyebrows require precise alignment.
• Consider referral to a specialist for complex lacerations involving nerves, muscles, or those requiring extensive repair. The use of topical anesthetics, such as lidocaine, epinephrine, and tetracaine, can provide excellent wound anesthesia in 20 to 30 minutes, making the repair process less painful for patients 1. Overall, the goal of facial laceration management is to promote healing, minimize scarring, and prevent infection, while also considering the cosmetic and functional implications of the injury.

From the Research

Facial Laceration Management

• The primary goals of laceration repair are to achieve hemostasis and optimal cosmetic results without increasing the risk of infection 2.
• There is no defined "golden period" for wound repair, and it may be reasonable to close wounds even 18 or more hours after injury, depending on the type of wound 2.
• The use of nonsterile gloves and irrigation with potable tap water does not increase the risk of wound infection 2.

Anesthetic and Wound Closure

• Local anesthetic with epinephrine in a concentration of up to 1:100,000 is safe for use on digits, and 1:200,000 is safe for use on the nose and ears 2.
• Tissue adhesives and wound adhesive strips can be used effectively in low-tension skin areas 2.
• Wounds heal faster in a moist environment, and occlusive and semiocclusive dressings should be considered when available 2.

Antibiotic Prophylaxis

• The Surgical Infection Society recommends against the use of prophylactic antibiotics for adult patients with mandibular or non-mandibular facial fractures undergoing non-operative or operative procedures 3, 4.
• A narrow-spectrum antibiotic such as cefazolin may be considered for prophylaxis, administered within 1 hour of surgery and no longer than 24 hours after surgery 4.

General Management

• Laceration injuries comprise a significant volume of emergency department visits, and emergency physicians should be comfortable treating these types of injuries 5.
• Abrasion and laceration management begins with controlling bleeding, assessing the wound site, and determining the patient's tetanus status 6.
• Guidelines for return-to-play decisions and follow-up care should be considered in the management of facial lacerations 6.