Each year, more than 12 million wounds are treated in emergency departments (EDs) across the United States.1 The most cosmetically devastating are those that appear on the face; therefore careful evaluation and meticulous repair technique are important for excellent results. The emergency physician can repair the majority of facial lacerations; however, because of the cosmetic impact of these wounds, consultation with specialists is encouraged when the technical aspects of closure exceed the physician's ability. In addition, the patient may insist on a specialist to repair such wounds as are readily visible. Wounds to the face that involve areas of tissue avulsion may best be repaired primarily in the operating room so that flaps or grafts can be applied. When the emergency physician initially evaluates the wound, it should be cleaned and properly irrigated even if a delayed repair by a specialist is anticipated.
In today's society, a growing number of victims of domestic violence are being identified in the ED. Anyone with facial trauma should be questioned about the possibility of domestic violence; if this is strongly suspected, appropriate authorities should be notified. Prompt identification and intervention are critical in preventing future injury.23
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