Treatment of Facial Trauma Wounds for Optimal Scars

The face is the most conspicuous part of the human body. Therefore, any injury that occurs in this area will have the potential to cause complications that interfere with the quality of life of the individual concerned. Therefore, wound management must be carried out optimally and comprehensively.

 

Causes and Forms of Facial Trauma

Trauma to the face can be caused by various things, such as:

• Motor vehicle accident

• Violence, eg. fight case

• Animal attacks, eg. animal bite or scratch

• Fall down
• Recreational/sports activities, e.g. impact ball, knee, etc
• Yourself, eg. mental disorder patient

Facial sores can take many forms and involve:

• Soft tissue (scratches, bruises, tears, punctures, etc.)

• Hard tissue (facial fractures, broken/loose teeth, etc.)

Facial Trauma Management

As with all trauma cases, patient management begins with a primary survey. At this step, health workers detect an emergency that requires immediate treatment. Cases of facial injuries alone, while they may appear conspicuous, rarely cause a life-threatening emergency. But sometimes trauma is accompanied by injury to other areas of the body which can lead to more urgent complications. In cases of facial trauma, the most common emergencies include airway obstruction, spinal cord injury, and central nervous system injury. For this reason, an evaluation by a multidisciplinary medical team in a health facility that has adequate facilities and infrastructure is required.

Only after the general condition of the patient is assessed to be stable can a thorough examination and management be carried out, including the treatment of facial wounds. Generally the wound is cleaned, then closed. Wound closure procedures can be carried out with wound care alone or surgical procedures such as wound suturing. Patients also receive treatment such as antitetanus, antibiotics, and painkillers as indicated.

When Should a Plastic Surgeon Be Treated

Cases of facial trauma should be treated by a plastic surgeon if:

• Complex wounds (eg lacerations with ragged edges, dirty wounds)
  

• Injuries to areas that hold vital functions (eg eyelids, lips)

• There is a suspicion of damage to subcutaneous structures (nerves, blood vessels, glands, fractures, etc.)

Such cases require more detailed management, including specialized wound closure reconstructive procedures (eg wound sutures, skin grafts, etc.) and repair of critical structures (eg titanium plates to correct the position of the facial bones, wires to fixing teeth, etc.). With optimal management, it is hoped that the wound can heal within normal time limits without any short or long term complications such as infection, deformity, etc.

Scars on Facial Trauma

In a comprehensive management, management should include:

• Wound planning. In "deliberate" injuries, such as facial surgery, the wound can be "designed" to produce a faint scar.

• Injury cure. Wounds that arise are treated so that the healing process runs smoothly. This stage includes cleaning the wound and closing the wound with appropriate procedures.

• Scar treatment after the wound has healed. After healing, the scar still undergoes a maturation period that lasts for at least 6 months. It is during this period that the plastic surgeon treats the scar and performs additional interventions if needed.

It is hoped that even if it doesn't disappear 100%, the resulting scars will be subtle and hidden. Comprehensive scar management also aims to prevent abnormal scars that protrude (keloids, hypertrophic scars), sunken (atrophic scars), or interfere with other surrounding structures (contractures).

As a comprehensive field of science, plastic surgeons do not only heal wounds, but also try to make the scars as subtle as possible, especially if the wound occurs in a vital body area such as the face. With appropriate management, it is hoped that the patient can achieve the maximum possible form and function for an optimal quality of life.



Created by : dr. Sandy Sofian Sopandi, Sp.B-RE