Wound Preparation

Routine wound care should be undertaken. Sedation may be required to ensure that the patient is safe and relaxed during the procedure. 8 Anesthesia can be provided by topical, local, or regional infiltration. A supraorbital block can be used to anesthetize one side of the forehead and anterior third of the scalp. The advantage of a regional block in the face is that the volume of locally instilled anesthetic does not distort the wound. 9 Local anesthetics containing epinephrine are often used in these highly vascular wounds to help control hemorrhage from small vessels. While many clinicians describe this effect, there are few data to support the belief that epinephrine reduces bleeding during wound repair. Conversely, the theoretical adverse effects of added epinephrine (increased risk of infection, ischemia of portions of the wound with poor circulation, and cardiovascular effects of epinephrine) are rarely an issue with facial and scalp lacerations. Thus, the use of a local anesthetic with or without epinephrine is a matter of personal preference. Topical agents such as TAC (tetracaine-adrenaline-cocaine) or LET (lidocaine-epinephrine-tetracaine) may be useful in this area. 1 ,.11 LET has several practical advantages and is recommended over TAC.

All traumatic wounds are commonly irrigated to reduce contamination and lessen the risk of wound infection. However, in nonbite, noncontaminated facial and scalp wounds presenting within 6 h, routine irrigation does not alter the rate of infection or subsequent cosmetic appearance after suture repair. 12 Regardless of irrigation, the overall incidence of wound infection in sutured scalp and facial wounds is about 1 percent.

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