What is the treatment for a facial laceration on the forehead with swelling?

Treatment of Facial Forehead Laceration with Swelling

For a facial laceration on the forehead with swelling, immediately cleanse the wound with sterile normal saline, apply topical anesthetic (LET or lidocaine) for 20-30 minutes, then close with Steri-Strips or tissue adhesive for low-tension wounds, or use buffered lidocaine injection followed by absorbable sutures for wounds requiring suturing—all while elevating the injured area to reduce swelling.

Initial Assessment and Wound Preparation

Critical first steps:

• Cleanse the wound thoroughly with sterile normal saline (no need for iodine- or antibiotic-containing solutions) and remove superficial debris 1
• Elevate the injured forehead area during the first few days after injury, as elevation of swollen body parts accelerates healing 1
• Assess for deeper injuries including nerve damage, tendon injury, or periosteal penetration—pain disproportionate to injury severity suggests bone involvement 1

Pain Management Strategy

Topical anesthesia (preferred for facial wounds):

• Apply LET (lidocaine, epinephrine, and tetracaine) solution directly to the open wound, cover with occlusive dressing, and allow 10-20 minutes for wound edges to blanch 1
• Dose: 3 mL for patients >17 kg; 0.175 mL/kg for patients <17 kg 1
• Contraindications: allergy to amide anesthetics or gross wound contamination 1

Injectable anesthesia (if topical insufficient):

• Use buffered lidocaine with bicarbonate, warmed before injection, administered slowly with a small-gauge needle to minimize pain 1
• This technique provides nearly painless injection when performed correctly 1

Wound Closure Technique Selection

For low-tension forehead wounds:

• Steri-Strips provide essentially painless closure and are particularly useful for facial wounds requiring gentle approximation to minimize scarring 1, 2
• Tissue adhesives (octyl cyanoacrylate) offer painless closure for appropriate low-tension wounds 1
• Both options avoid the pain and anxiety of suture removal 1

For wounds requiring suturing:

• Use absorbable sutures for facial wounds to avoid the pain and anxiety of suture removal 1
• Facial wounds can be closed primarily if seen early (<8 hours after injury) with meticulous wound care, copious irrigation, and proper technique 1
• Wounds on the face are an exception to standard closure timing and can be managed more aggressively than wounds elsewhere 1

Timing and Follow-up

Steri-Strip/closure material duration:

• For facial lacerations, Steri-Strips should remain in place for 5-7 days due to the excellent blood supply and rapid healing of facial tissue 2, 3
• Before removal, assess for complete wound edge approximation, absence of significant swelling or erythema, and no signs of infection 2, 3
• Removing closure materials too early (before 5 days) risks wound dehiscence; leaving them too long increases risk of skin irritation 2, 3

Wound care during healing:

• Keep the wound covered with a sterile dressing for the first 48 hours unless leakage occurs 2
• Change dressing daily with local disinfection during days 1-7 2
• After initial healing, wound cleansing can be performed every 2-3 days 2

Adjunctive Measures for Swelling

Immediate management:

• Elevation is critical—use passive methods (sling or similar support) to keep the forehead elevated, especially during the first few days 1
• Consider ice application if clean running water is not available for initial cooling, though this is more relevant for thermal injuries 1

Medication:

• Administer over-the-counter analgesics (acetaminophen or NSAIDs) for pain management 1

Critical Pitfalls to Avoid

Do not close infected wounds:

• Infected wounds should never be closed primarily 1
• If infection is present or develops, wounds require prolonged therapy and may need reopening 1

Avoid premature closure:

• Suturing controversial wounds early (<8 hours) requires meticulous technique—when in doubt, use Steri-Strips for approximation with delayed primary or secondary closure 1

Monitor for complications:

• Follow up within 24 hours either by phone or office visit 1
• Watch for signs requiring hospitalization: progression despite treatment, increasing pain suggesting deeper involvement, or systemic signs 1

Tetanus Prophylaxis

• Ensure tetanus status is current—if outdated or unknown, administer 0.5 mL tetanus toxoid intramuscularly 1