Though all surgeons close wounds, there are times when the special skill of a plastic surgeon is needed. They are the best experts in wound care and their expertise can improve healing and reduce scarring when a wound is large, jagged or cannot be covered with the skin currently at the site. However, every individual , the injury and its surgery is unique.
Closure of skin lacerations is required when the wound extends deeper through the dermis and is likely to cause excess scarring if the wound edges are not properly opposed. Sutures ( stitches ) are preferred when the wound requires careful approximation
●Clean, uninfected lacerations on any part of the body in healthy patients may be closed primarily for up to 18 hours following the injury without a significant increase in the risk of wound infection.
●Because of the lower risk of infection or poor wound healing, facial wounds may be closed primarily up to 24 hours following the injury in all patients. In selected patients (no signs of infection, otherwise healthy patient, and easily approximated wound), closure of facial wounds may occur up to 48 to 72 hours after injury.
Some lacerations that meet criteria for closure with sutures may also be amenable to closure with staples, skin adhesives, or wound closure tapes
GUIDELINES FOR SURGICAL CONSULTATION
Consultation with a plastic surgeon or other surgical specialist is warranted for the following wounds:
●Large or complex laceration that will require prolonged repair or grafting
●Severe contamination that cannot be properly managed at the bedside under local anesthesia
●Neurovascular compromise present
●Fracture, amputation, or joint penetration (eg, laceration through the knee joint capsule) associated with the laceration
●Anatomic sites requiring specialized repair to ensure optimal cosmetic outcomes:
•The nasal cartilage, ala, or columella
•Eyelid or orbital lacerations that involve the eyelid margin or tarsal plate, have protruding subcutaneous fat, or involve the tear duct or lacrimal gland
Depending upon the provider’s experience and ability to follow the wound until full healing, strong concern about cosmetic outcome by either the patient or family may also be a reason for referring a laceration to a surgeon for closure. However, for experienced providers, the outcome of clean skin lacerations in low-risk patients (eg, healthy children) is similar regardless of who performs the primary closure.