PST wounds I category

A cut on the face may look small, but dirt, glass or damaged deeper tissue can remain under the skin. How the wound is treated in the first hours affects healing and the scar. At UKRMED Maxillofacial Surgery, surgeon Anna Kravchenko performs primary surgical treatment of wounds of the face, lips and mouth.

What primary surgical wound treatment is

It is the first surgical procedure on a fresh wound, aimed at preventing infection and allowing primary healing. It is not just applying antiseptic. The surgeon cleans the wound, removes foreign bodies and non-viable tissue, stops the bleeding and aligns the edges.

Primary and secondary treatment

• Primary — on a fresh wound, in the first hours or days after injury.
• Secondary — later, if the wound has become infected or is healing with complications: the surgeon reopens, cleans and drains it.

Which wounds are category I

• superficial cuts and tears of the skin of the face, lips and chin;
• wounds of the lining of the lips, cheeks and tongue;
• small area, without injury to bones, nerves or salivary ducts.

Large, deep, contaminated or bite wounds, or those involving deeper structures, are category II. If a fracture is suspected, CT is ordered.

Features of facial wounds

The face has a rich blood supply, so wounds here heal faster and become infected less often than on the body. Precision matters, though: even a millimetre's misalignment at the lip border or eyelid edge becomes visible. The surgeon therefore aligns the edges layer by layer — lining, muscle, skin — using fine suture material.

Steps

1. Examination: depth, contamination, foreign bodies, facial muscle movement and sensation.
2. Local anaesthesia.
3. Irrigation with plenty of solution, removing dirt and particles.
4. Excision of non-viable tissue — sparingly on the face, which has a good blood supply.
5. Control of bleeding.
6. Closure: a cosmetic suture or, for small straight wounds, medical glue.

A Cochrane review found that for simple straight wounds, tissue adhesive gives the same cosmetic result as stitches and is quicker and less painful, although edges separate slightly more often. Lips, the area around the eyes and the lining of the mouth usually need fine stitches.

Tetanus vaccination

The US Centers for Disease Control and Prevention (CDC) recommend a tetanus booster for a contaminated wound if more than 5 years have passed since the last dose, and for a clean wound after more than 10 years. Bring your vaccination record.

Aftercare

• Keep the stitches clean and dry for the first day.
• Care for the wound as the doctor advises.
• Facial stitches are removed after 5–7 days.
• Protect the scar from the sun for several months.

Come back immediately if redness and swelling increase, or pus or fever appear. If the healed scar is noticeable, it can be improved with scar revision.

Possible complications

• Infection — redness, swelling, pain and discharge on days two to four. The wound must be checked: sometimes some stitches are removed and an antibiotic is prescribed.
• Wound opening — more likely with tension, injury to the stitches or early removal. Small gaps heal on their own; larger ones are re-sutured.
• Hypertrophic scar or keloid — the tendency is inherited; tell the doctor if you have had such scars before.
• Reaction to suture material — rare, as redness around the stitches.

Prices at UKRMED

The final cost depends on the wound size and number of stitches; the surgeon gives it after examination.

Sources

1. Farion K., Osmond M. H., Hartling L. et al. Tissue adhesives for traumatic lacerations in children and adults. Cochrane Database Syst Rev, 2002. https://doi.org/10.1002/14651858.CD003326
2. Centers for Disease Control and Prevention (CDC). Tetanus: Clinical Guidance — wound management. https://www.cdc.gov/tetanus/hcp/clinical-guidance/index.html