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Lacerations
Nima Shemirani
Eos Rejuvenation
Lasky Clinic, Beverly Hills CA
Objectives
Evaluation of patient
Principles of wound
management
Reference
Anatomy of a needle
3 parts: point,
body and
swage
Needle is
rounded at
swage end
Needle is flat
within body
(best place to
grab with
needle driver
Anatomy of a needle
(cont)
A = swage
(needle
rotates)
B= body
(needle
secure)
C= point
(point is
blunted)
Needle choices
Jaws of needle driver should approximate 3035% of the length of the needle
A= just right
B= too big C= too small
Suture choices
Importance of eversion
Wound will
contract over
time
Need to evert
wound edges
to prevent
depressions
and widening
of scar
Injection
Forehead
Example of SubCuticular
Eyelid
Example of a bad
outcome
Example of a bad
outcome
Lip
Lip Closure
Regional Blocks
Ear
Timing of repair
Cosmetic appearance
score
From Wound Registry:
Hollander Wound
Evaluation Scale
Assessing outcomes in
facial plastic surgery
(Rhee
et
al
2008)
Review of all outcomes in facial
Ethibond vs
Monofilament (Quinn
1998)
Paid for by manufacturers of Ethibond
Results of Ethibond
closure
Cochrane review of
tissue adhesives (2001,
updated 2007)
Used VAS and cosmetic wound score to
Limitations
Comparison of nylon,
fast gut and Dermabond
(Holger
2004)
Metanalysis of
absorbable vs nonabsorbable suture (AlAbdullah 2007)
Choice of
irrigant/cleanser
Role of antimicrobials
Extremes of age
DM, renal disease
Immunocompromised state
Malnutrition
Obesity
Bite injuries (Amox/clav x 3-5 days to cover Eikenella,
Pasturella)
Crush injuries
Grossly contaminated wounds
Laceration involving muscle
Open fractures
Intraoral lacerations (5 days of PCN adequate)
Appropriate use of
antibiotics
Practice
Conclusions