Facial lacerations are open wounds that occur following falls, accidents or interpersonal violence. They present in the acute setting with pain and bleeding. Untreated facial lacerations tend to heal with a depressed scar and present with aesthetic deformities and/or scar distortion of delicate critical structures, such as the eyelids, nose and lips.
The face contains a few well-defined layers of tissues. The skin covering the face is highly specialized and its characteristic varies greatly depending on its anatomical location. The skin of the scalp is the thickest skin in the body and has the highest density of hair follicles. Conversely, the upper eyelid skin is the thinnest skin in the human. Beneath the skin lies the subcutaneous fat, which is also of varying thickness in different people and different parts of the face.
The facial muscle layer lies deep to the subcutaneous fat. The muscle layer in the face is also unique – there are direct connections between the muscle and the skin and this permits facial expression, a special function of the face that is not observed in any other part of the human anatomy.
The deepest layer of the face is the bony skeleton.
There are two mechanisms causing facial lacerations: Sharp or blunt injuries.
Sharp injuries are caused by penetration of the skin and underlying tissues with a pointed object. These may be partial- or full- thickness depending on the nature of the object and the force and vector of the injury. Blunt injuries are more common and are usually observed when individuals fall or accidentally bump against a hard surface. Blunt injuries often occur over the facial bony prominences (e.g. the eye sockets, cheeks and chin) and are caused by the compression of the soft tissue between the facial skeleton and the hard surface, causing the former to split. Consequently, blunt injuries tend cause full thickness lacerations involving skin, subcutaneous fat and muscle.
Our face is part of our identity and bears the marks of our life history. All societies and cultures place significant emphasis on facial appearance. Optimal management of facial lacerations is important to prevent unfavorable scars, which may affect an individual’s body image, self-confidence, and social functioning.
Because the facial muscles insert directly into the skin, they constantly exert traction on the wound and stimulate the production of abnormal amounts of collagen into the wound, resulting in an unsightly raised hypertrophic scar in some cases. Cases involving deep facial lacerations often result in the skin healing onto the underlying muscle (which is also often split) resulting in depressed scars.
Facial lacerations that do not receive early surgical management may also become infected, resulting in delayed wound healing and developing unfavorable scars.
Facial lacerations are best managed immediately following the accident as this permit removal of wound contamination and direct wound closure for optimal result. Optimal results are obtained by applying meticulous wound closure techniques by experienced plastic surgeons in Singapore. Private hospitals give individuals the best access to specialist-level care and operating facilities where required.
Minor lacerations in older children and adults may be washed and closed in the emergency department. More extensive lacerations or those involving delicate critical structures (e.g. eyelids) may require repair in the operating room. Occasionally, lacerations involving critical structures (e.g. nerves, blood vessels) may require microsurgical techniques for repair, where ultra-fine sutures that are thinner than a strand of hair are used to rejoin the cut structures.
Lacerations in young children may be repaired under general anesthesia in the operating room or under ketamine sedation in the Emergency Department. The latter is administered by specially-trained Emergency Medicine physicians or anesthesiologists.
Non-resorbable sutures are used in adults for optimal scar result and these are removed on the 5th postoperative day. Resorbable stitches are normally used in young children who are unable to cooperate with stitch removal in the clinic. These will normally dissolve after 2 to 3 weeks.
Scar management is commenced one week postoperatively and continued for one to two months for optimal scar outcome.