Facial Lacerations / Soft-Tissue Avulsion Repair | Wound care and early complications

No cleansing is advised for the first 24 hours after operation because it may start bleeding. After that, intraoral sutures can trap food, so clinging debris should be removed by swabbing with cotton wool each day. A hypertonic saline mouth bath, as hot as you can bear without scalding, may be allowed to lie over the wound until cool. No violent flushing is advised. Mouth brushing on normal teeth and gums should start as soon as possible, with techniques supervised before discharge. If arch bars or obturators are present, they may be cleaned with a toothbrush and paste, and chlorhexidine mouthwash can be used with obturators.

An avulsion is a full-thickness wound with tissue loss; repair aims to bring separated tissue close together, sometimes with small tacking stitches. A gentle pressure dressing may reduce fluid accumulation beneath it, helping the wound stay visible for infection checks and local care. Do not press directly on the repair; follow your surgeon's dressing plan and activity limits as advised after surgery. In avulsion lacerations, an elevated flap can create a trapdoor defect that obstructs lymphatic and venous drainage, predisposing to contour deformity; careful handling, trimming to viable bleeding edges, and pressure dressing improve long-term result. Wet-to-dry dressings may debride the wound and allow granulation tissue. For repaired avulsions with fragile blood supply, leech therapy may reduce swelling and congestion.

Facial sutures are usually removed within 3 to 5 days to reduce suture marks; elsewhere on the face, 4 to 6 days; eyelids 3 to 4 days; ears 10 days. Nonabsorbable sutures are often removed in 5 to 7 days. Larger lacerations over 2 cm are supported by wound tape for 1 week after suture removal. Separation can follow tension, movement, infection, or incomplete healing, and management depends on size, location, depth, contamination, and whether deeper structures were involved. Daily gentle cleansing and a small amount of antibiotic ointment may be used after repair. Your clinician will decide whether observation, tape, or re-closure is appropriate.

Infection is diagnosed clinically, not by routine swabbing alone, because many wounds are colonised with bacteria that do not cause infection. Warning signs include increasing pain, spreading redness, warmth, swelling, fever, pus, more drainage or a change in its colour, odour, discolouration of healing tissue, or failure to heal. A narrow red margin and slight thin bloody drainage for one to two days can be normal. If the diagnosis is unclear, re-examination in 24 hours may show whether infection is developing. People who are immunocompromised or diabetic may show fewer inflammatory signs and may need a swab if healing stalls.

The parotid duct runs through the cheek and drains saliva into the mouth. Injury is suspected with cheek lacerations, especially when the buccal branch of the facial nerve is also injured, because the two lie close together. There may be no immediate sign; saliva often starts draining from the wound days later. The duct opening can be cannulated and injected with methylene blue or saline to check for injury. If lacerated, repair is done over a small feeding tube left as a stent for 14 days, with a subcutaneous drain for one week and external pressure for the first 48 hours to help prevent sialocele.

Facial lacerations should be explored for duct or nerve branch injury, then closed in layers with attention to free margins. Infection and bleeding are potential complications of any surgical procedure. Avulsion injuries can create trapdoor defects that heal unpredictably and may cause contour deformities. Even with symmetrical lip movement, an occlusal cant or inherent facial bone asymmetry can make a smile look uneven. Some procedures may correct minor asymmetries, while others will not and could accentuate them. Preoperative asymmetries may persist after surgery, so identifying them beforehand matters. Careful repair aims to protect function and appearance, but no result can be guaranteed.

During the open wound phase, no sunscreen or makeup is worn, and strict sun avoidance is imperative to reduce hyperpigmentation risk. Re-epithelialization may take 3 days after superficial procedures or up to 14 days with deeper wounds. Close shaving can create tiny skin cuts that may act as bacterial entry points; clipping hair with scissors or using a recessed-blade razor avoids dermal damage. Eyebrow hair should never be shaved or clipped because regrowth is unpredictable and brow borders help align the repair. The exact day depends on wound depth and your surgeon's assessment; do not apply makeup over an open or crusted area. Post-resurfacing skincare should restart only once the wound is re-epithelialized and tolerated.

Children may not understand why stitches must stay in place, so care is practical and supervised. Absorbable sutures can be used on the face with similar cosmetic results, but some still need removal if not dissolved within 5 to 7 days; parents may gently rub them off with moistened gauze. Topical antibiotic ointment may reduce infection and keep the wound moist; extra covering has not been shown to reduce infection or improve healing, and the wound may be wet after 12 hours without increased infection. Elbow restraints are often useful in young or developmentally delayed children; in one cleft-lip study, arm restraints and mittens showed no significant difference in scar or complications.

Elevating a cutaneous flap impairs vascular supply and causes ischemia; perfusion pressure falls, especially farther from the flap base, though adjacent vascular territories may provide low-pressure flow through the subdermal plexus. In avulsion injuries, a trapdoor defect may create lymphatic and venous obstruction, and venous congestion has been described in facial avulsion injuries. Flaps that are distally based rely solely on venous backflow for oxygen and nutrients, while proximally based flaps usually have adequate perfusion, though repair must still be careful. Because skin has relatively low nutritional requirements, several vascular territories can be compromised before necrosis results. These visible changes can warn that drainage or blood supply is compromised.