What is the proper method for prepping and cleaning an eyebrow laceration prior to suturing?

Proper Preparation and Cleaning of Eyebrow Lacerations Prior to Suturing

Eyebrow lacerations should be irrigated with copious amounts of tap water or normal saline under pressure to thoroughly clean the wound before suturing. 1

Initial Assessment and Preparation

1. Wound Cleaning Protocol:

   • Clean the corneal surface with balanced salt solution, removing excess fluid so the surface is moist but not wet 1
   • For the laceration itself, irrigate with high volumes (100-1000 mL) of tap water or normal saline 1
   • Use higher irrigation pressures for more effective cleaning 1

2. Irrigation Technique:

   • Use a 20-30 mL syringe with an 18-gauge catheter/needle to create adequate pressure for irrigation
   • Body temperature saline is more comfortable for the patient than cold saline 1
   • Consider adding soap to water for more effective cleaning than saline alone 1

3. Hair Management:

   • Do NOT shave or trim eyebrow hair, as this can lead to permanent changes in hair growth pattern
   • Instead, gently clean around the hairs and carefully part them to access the wound
   • Eyebrow hair serves as an important anatomical landmark for proper alignment during repair 2

Anesthetic Considerations

1. Topical Anesthesia:

   • Apply topical anesthetic/vasoconstrictor combinations (e.g., LET - lidocaine, epinephrine, tetracaine) to the wound for 10-20 minutes until wound edges appear blanched 1
   • For children >17 kg: use 3 mL of LET solution
   • For children <17 kg: use 0.175 mL/kg of LET solution 1

2. Injectable Anesthesia:

   • After topical anesthesia takes effect, consider supplemental local anesthesia
   • For nearly painless injection: use buffered lidocaine, warmed to body temperature, injected slowly with a small-gauge needle 1
   • Local anesthetic with epinephrine in concentration of 1:200,000 is safe for use on facial areas including the eyebrow region 3

Wound Assessment and Debridement

1. Examination:

   • After cleaning, thoroughly examine the wound for:
     • Foreign bodies
     • Depth of injury (check for periosteal involvement)
     • Damage to underlying structures (nerves, blood vessels)
   • Consider radiographic examination if foreign body is suspected 4

2. Debridement:

   • Remove superficial debris during irrigation
   • Deeper debridement should be done cautiously to avoid enlarging the wound and impairing skin closure 1
   • Minimal debridement is typically required for clean lacerations

Special Considerations

1. Timing of Repair:

   • While the traditional "golden period" concept has been challenged, earlier repair generally yields better cosmetic results
   • Facial lacerations may be closed primarily even after several hours if thoroughly cleaned 3

2. Infection Prevention:

   • Nonsterile gloves can be used without increasing infection risk 3
   • Prophylactic antibiotics are generally not required for simple eyebrow lacerations unless grossly contaminated

3. Wound Closure Technique:

   • Ensure accurate coaptation of the dermis for wound strength
   • Align the epidermis precisely for optimal cosmetic results 4
   • Consider using tissue adhesives or wound adhesive strips for superficial lacerations in this low-tension area 3

Common Pitfalls to Avoid

1. Never shave or trim eyebrow hair - this can lead to permanent changes in hair growth pattern and complicate proper anatomical alignment

2. Avoid excessive pressure during irrigation near the eye - direct irrigation stream parallel to the eye, not toward it

3. Don't close infected or grossly contaminated wounds - these should be left open or closed by delayed primary intention 1

4. Avoid full-thickness sutures in the eyebrow region except in specific circumstances 4

5. Don't forget tetanus prophylaxis if indicated based on immunization status 3

By following this systematic approach to cleaning and preparing eyebrow lacerations, you can minimize infection risk and optimize cosmetic outcomes for your patients.