Facial Soft Tissue Trauma

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Careful analysis of the soft tissue injury should include: (1) the type of wound or wounds (abrasion, contusion, etc); (2) the cause of injury; (3) the age of the injury; (4) the location of injured tissues; (5) the degree of contamination of the injured area before, during, and after trauma; (6) the nature and extent of associated injuries; and (7) the general health of the patient (eg, any chronic or acute illnesses or any allergies; any medications being taken).

The location of the wound must be noted because different healing characteristics are present in various types of skin. The face and scalp are highly vascular and therefore resist infection and heal faster than other areas, but there are many important structures in and around the face, and scars and defects are noticeable. Skin of the trunk, upper arms, and thighs is fairly thick and heals more slowly than facial or scalp skin and is more susceptible to infection. Scarring is less noticeable. The hands are a critical area because there are important structures near the surface, and the destruction caused by infection can be devastating. The lower legs are a particular problem area because the relatively poor blood supply can cause skin loss, and infection is more likely to occur.

The final result of facial wound repair depends on the nature and location of the wounds, individual propensity to scar formation, and the passage of time. A year or more must often pass before resolution of scar contracture and erythema results in maximum improvement. Only after this time can a decision be made regarding the desirability of secondary scar revision.

Figure Legend: Lines of relaxed skin tension. Plastic and Reconstructive Surgery, Brunicardi F, Andersen DK, Billiar TR, Dunn DL, Kao LS, Hunter JG, Matthews JB, Pollock RE. Schwartz's Principles of Surgery, 11e; 2019. 

Board Review Questions

Choose the one best response to this question...

1. Principles of reconstructive surgery include all of the following EXCEPT

A. Adequate restoration of lost anatomic components without residual deficits.


B. Uncomplicated and timely wound healing.


C. Individualization of specific reconstructive technique to specific patient deficit.


D. Compromise of extent of tumor resection if needed for specific reconstructive surgical outcome.


2. What is the third layer of the epidermis called?

A. Stratum basalis


B. Stratum spinosum


C. Stratum lucidum


D. Stratum granulosum

3. How does a skin graft survive within the first 24 hours?

A. Capillary network neovascularization


B. Neovascularization


C. Imbibition


D. Oxygen diffusion from open air

Answers

1. The correct answer is D. Compromise of extent of tumor resection if needed for specific reconstructive surgical outcome.

2. The correct answer is D. Stratum granulosum

3. The correct answer is C. Imbibition

Gerard Doherty

Moseley Professor of Surgery, Harvard Medical School, Surgeon-in-Chief, Brigham Health & Dana-Farber Cancer Institute

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