Definition & Overview
The simple repair of superficial wounds of face, ears, eyelids, nose, lips, and/or mucous membrane refers to the medical procedure used to treat minor wounds that affect only the top layer of the skin. These superficial wounds only require simple, one-layer closure using different techniques depending on which part of the body is affected.
In general, a simple wound repair refers to a wound management procedure that does not require sutures. It may, however, require electrocauterisation or the use of adhesive strips if the wound needs to be closed artificially. It is one of the three classifications of wound repair, the others being intermediate and complex repairs, which are used for more severe wounds.
Who Should Undergo and Expected Results
Patients who should undergo the procedure are those who suffer from minor wounds affecting the face and its various features. These wounds affect only the topmost layer of the skin called the epidermis. Superficial wounds are considered as open wounds and may be classified as the following depending on the cause and manner of injury:
- Abrasions or grazes
- Puncture wound
- Minor burn wound
Since this type of wound affects the face and facial features, several unique factors need to be considered when they are treated as people are especially concerned about facial scars.
Fortunately, some of the unique characteristics of facial skin make it easier to treat than the skin covering the rest of the body. Since facial skin is naturally lax, the risk of tissue loss and swelling is significantly reduced. Also, the face has a more abundant blood supply and is thus likely to heal faster. Moreover, while most wounds need to be treated within 6 hours after the injury, facial wounds can be treated even the day after the injury, for so long as the wound is thoroughly cleansed. In addition, the risk of infection of superficial facial wounds is quite low. Thus, a simple repair of superficial wounds of face, ears, eyelids, nose, lips, and/or mucous membrane is usually effective and may leave only minimal scarring.
How is the Procedure Performed?
During a simple repair of superficial wounds, the doctor will first examine the wounded area to determine the extent of the injury, to assess any other possible danger, and to check for contamination. For superficial wounds that do not damage the deeper structures, such as the nerves and tendons, the doctor will use a simple repair procedure and assess whether sedation or anaesthesia is necessary.
If there is contamination, the procedure will begin with the cleansing of the wound and removal of any foreign bodies and debris. Debridement is mostly not necessary, as damaged tissue in the face has a good chance of healing due to the face’s abundant blood supply, unless the tissue is visibly dead.
The wound is then treated with an antibacterial solution before it is repaired. Doctors are more careful in applying an antibacterial solution to wounds in the face, especially those that affect the nose and the eyelids. In most cases, the solution is limited to a 10% mixture of povidone iodone as this can be used safely around the eyes and even on the mucous membrane.
If anaesthesia is required, doctors generally use lidocaine with epinephrine or plain lidocaine, which is the better choice especially for wounds on the nose. For small superficial wounds, the anaesthetic is usually injected along the edges of the wound. For larger but still superficial wounds, nerve blocks are more widely preferred.
For mucosal wounds, or wounds that occur inside the mouth, the key to a successful simple repair is to make sure the wet-dry border is aligned well. It is also important not to affect the opening of the parotid duct during the treatment. Parotid duct is the small raised mound of oral mucosa located just inside the cheek near the upper second molar.
After the wound is treated, doctors will place a piece of sterile gauze over it to protect it as it heals.
Possible Risks and Complications
As infection is a common risk for any type of wound, patients who undergo a simple repair for superficial wounds of the face and its different parts should also receive proper antibiotic solutions or ointments while being treated. However, for wounds that affect the eyelids, there is a risk that regular antibiotics may cause conjunctivitis, a condition characterised by redness and inflammation of the thin layer of tissue that covers the front of the eye or the conjunctiva. The condition is also known as pinkeye. To avoid this complication, doctors typically use ophthalmic-grade antibiotic ointments for all wounds near the eyes.
Some anaesthesia-related complications may also occur. Aside from the typical risk of allergic reactions, anaesthetics can also irritate or injure some parts of the face. This is why doctors tend to be very specific in their choice of anaesthetics when treating facial wounds.
Bhattacharya V. “Management of soft tissue wounds of the face.” Indian J Plast Surg. 2012 Sep-Dec; 45(3). http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3580340/
“Clinical Practice Guidelines: Lacerations.” The Royal Children’s Hospital Melbourne. http://www.rch.org.au/clinicalguide/guideline_index/lacerations/