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Park BK, Min JH, Park JS, You YH, Jeong WJ, Cho YC, Oh SK, In YN, Ahn HJ, Kang CS, Kyung HW, Kim JH, Yang HJ, Lee BK, Yoo HJ. Tailored versus conventional surgical debridement in complex facial lacerations in emergency department: A retrospective study. Medicine (Baltimore) 2023; 102:e33572. [PMID: 37115088 PMCID: PMC10145807 DOI: 10.1097/md.0000000000033572] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 03/28/2023] [Accepted: 03/29/2023] [Indexed: 04/29/2023] Open
Abstract
Surgical debridement is an essential step in treating complex facial lacerations (CFL). As the CFL severity increases, conventional surgical debridement (CSD) of wound edges becomes difficult and may be insufficient. Because the severity and shape of each CFL vary, it is necessary to tailor the customized pre-excisional design, that is, tailored surgical debridement (TSD), for each case before performing surgical debridement. The use of TSD can enable effective debridement of CFL with higher severity. This study aimed to compare the cosmetic outcomes and complication incidence of CSD versus TSD according to CFL severity. In this retrospective observational study, eligible patients with CFL who visited the emergency department between August 2020 and December 2021 were examined. CFL severity was graded as Grades I and II. The outcomes of CSD and TSD were compared using the scar cosmesis assessment and rating (SCAR) scale, wherein a good cosmetic outcome was defined as a SCAR score of ≤ 2. The percentage of good cosmetic outcomes between the 2 groups was compared. The SCAR score and percentage of good cosmetic outcomes between the 2 groups were compared overall and by severity. For analyzing complication incidence, asymmetry, infection, and dehiscence incidence were compared. In total, 252 patients were enrolled [121 (48.0%) CSD and 131 (52.0%) TSD]. The median SCAR scores were 3 (1-5) and 1 (0-2) in all enrolled patients (P < .001), 2 (0-4), and 1 (0-1) in Grade I patients (P < .01), and 5 (4-6) and 1 (1-2) in Grade II patients (P < .001) in the CSD and TSD groups, respectively. The percentage of good cosmetic outcomes was 46.3% and 84.0% overall (P < .001), 59.6% and 85.0% in Grade I patients (P < .01), and 9.4% and 83.5% in Grade II patients (P < .001) in the CSD and TSD groups, respectively. The incidence of complications was significantly higher in the CSD group than in the TSD group, but this was limited to asymmetry. No significant difference was noted in infection or dehiscence. Compared with CSD, TSD can lead to an objectively good cosmetic prognosis at higher CFL severity and can reduce facial asymmetry occurrence.
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Affiliation(s)
- Byeong Kwon Park
- Department of Emergency Medicine, Chungnam National University Hospital, Jung-gu, Daejeon, Republic of Korea
| | - Jin Hong Min
- Department of Emergency Medicine, College of Medicine, Chungnam National University, Jung-gu, Daejeon, Republic of Korea
- Department of Emergency Medicine, Chungnam National University Sejong Hospital, Sejong, Republic of Korea
| | - Jung Soo Park
- Department of Emergency Medicine, Chungnam National University Hospital, Jung-gu, Daejeon, Republic of Korea
- Department of Emergency Medicine, College of Medicine, Chungnam National University, Jung-gu, Daejeon, Republic of Korea
| | - Yeon Ho You
- Department of Emergency Medicine, Chungnam National University Hospital, Jung-gu, Daejeon, Republic of Korea
| | - Won Joon Jeong
- Department of Emergency Medicine, Chungnam National University Hospital, Jung-gu, Daejeon, Republic of Korea
- Department of Emergency Medicine, College of Medicine, Chungnam National University, Jung-gu, Daejeon, Republic of Korea
| | - Yong Chul Cho
- Department of Emergency Medicine, Chungnam National University Hospital, Jung-gu, Daejeon, Republic of Korea
| | - Se Kwang Oh
- Department of Emergency Medicine, College of Medicine, Chungnam National University, Jung-gu, Daejeon, Republic of Korea
- Department of Emergency Medicine, Chungnam National University Sejong Hospital, Sejong, Republic of Korea
| | - Yong Nam In
- Department of Emergency Medicine, College of Medicine, Chungnam National University, Jung-gu, Daejeon, Republic of Korea
- Department of Emergency Medicine, Chungnam National University Sejong Hospital, Sejong, Republic of Korea
| | - Hong Joon Ahn
- Department of Emergency Medicine, Chungnam National University Hospital, Jung-gu, Daejeon, Republic of Korea
- Department of Emergency Medicine, College of Medicine, Chungnam National University, Jung-gu, Daejeon, Republic of Korea
| | - Chang Shin Kang
- Department of Emergency Medicine, Chungnam National University Hospital, Jung-gu, Daejeon, Republic of Korea
| | - Hyun woo Kyung
- Department of Plastic Surgery, Chungnam National University Sejong Hospital, Sejong, Republic of Korea
- Department of Plastic Surgery, College of Medicine, Chungnam National University, Jung-gu, Daejeon, Republic of Korea
| | - Joo Hak Kim
- Department of Plastic Surgery, Chungnam National University Sejong Hospital, Sejong, Republic of Korea
| | - Ho Jik Yang
- Department of Plastic Surgery, Chungnam National University Sejong Hospital, Sejong, Republic of Korea
| | - Byung Kook Lee
- Department of Emergency Medicine, College of Medicine, Chonnam National University, Dong-gu, Gwangju, Republic of Korea
- Department of Emergency Medicine, Chonnam National University Hospital, Dong-gu, Gwangju, Republic of Korea
| | - Heon Jong Yoo
- Department of Obstetrics & Gynecology, Chungnam National University Sejong Hospital, Sejong, Republic of Korea
- Department of Obstetrics & Gynecology, College of Medicine, Chungnam National University, Jung-gu, Daejeon, Republic of Korea
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Basa K, Ezzat WH. Soft Tissue Trauma to the Nose: Management and Special Considerations. Facial Plast Surg 2021; 37:473-479. [PMID: 33853135 DOI: 10.1055/s-0041-1726440] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
The nose is one of the most common sites of facial injury due to its prominence and anatomical placement. Given its intricate anatomy, function, and high visibility, it also proves to be one of the most complex regions for repair. We provide a review of the management of soft tissue injuries to the nose, including the various reconstructive tools available and adjunctive wound care measures. We also discuss special considerations based on mechanism of injury and treatment of this condition in the pediatric population. The main goals of reconstruction should be to preserve function while achieving optimal cosmetic results in this highly visible region of the face.
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Affiliation(s)
- Krystyne Basa
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Boston University School of Medicine, Boston, Massachusetts
| | - Waleed H Ezzat
- Division of Facial Plastic and Reconstructive Surgery, Department of Otolaryngology-Head and Neck Surgery, Boston University School of Medicine, Boston, Massachusetts
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Abstract
One of the most impressive soft tissue injuries is the facial degloving, normally associated with industrial machines and traffic accidents. This injury is characterized by the separation of the skin and cartilage from the bones, compromising the soft tissues correlated in the trauma area, nerves, and blood vessels. A 28-year-old patient, male, was referred to Araçatuba's Santa Casa Hospital, after a motorcycle accident, hitting his face on the sidewalk. The patient was conscious, oriented, denying fainting and unconsciousness during the accident, and complaining of pain in the nasal region of the face. The suture of wounds was performed using 5-0 absorbable sutures for muscle planes, and reconstruction of the septum and nasal cartilages. The skin was sutured with interrupted stitches using 6-0 nylon. After reducing the edema, a slight increase in alar base was observed. Subsequently, the alar base cinch suture was performed aiming to bring the alar bases to a measure of 34.0 mm in diameter. As a conclusion, the knowledge of the anatomy of the region involved, the healing of tissues, and suture techniques for the facial region process were critical to the successful treatment. The evaluation of the alar base in degloving cases can involve aesthetic features.
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Abstract
The nose holds an outstanding position on the face, acquiring great importance within the context of facial aesthetics. Because of the functional, psychological, and social aspects of trauma in a society increasingly demanding about aesthetics, treatment institution must reduce, as accurate as possible, the sequelae that hinder social integration. This clinical report relates an immediate nasal reconstruction of a complex animal bite wound. A 7-year-old patient was victim of a dog bite with avulsion of the left nasal ala and part of the ipsilateral nasal tip. The treatment was immediate nasal reconstruction with auricular composite graft. After 1 year of follow-up, the shape of nasal ala was stable, and the color was consistent with the surrounding tissue. The 2 nasal sides exhibited satisfactory symmetry when evaluated. It can be concluded that the composite graft derived from the auricular helix is a safe option for reconstruction of nasal ala defects with compromised margins in pediatric patients when conditions of reimplantation do not exist.
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