FACIAL WOUNDS, LACERATIONS AND STITCHES
POSTOPERATIVE INSTRUCTIONS

Antibiotic Ointment

Keep the wounds covered with antibiotic ointment at all times.  This is very important because the top layer, also known as the epithelium, is able to heal about twice as fast if it is kept moist and is not allowed to dry out or form a scab. 

This is best accomplished by keeping a layer of greasy ointment over the cuts, scrapes, or wounded skin continuously. There is no fixed number of times that ointment should be applied. However, it may need to be applied as many as 10 or 15 times a day, in order to assure that the wound is continuously covered.

A wide variety of ointments may be used. A good selection is an antibiotic ointment such as Polysporin, Bacitracin or other comparable generic version of these. 

Antibiotic ointments containing antibiotic Neomycin are usually okay, but can cause a rash and for that reason may be better avoided.  Antibiotic ointments can be obtained over the counter, usually in the drug store or even in the grocery store. 

Although the antibiotic component of the ointment is beneficial, the most important component is the petroleum jelly base, which keeps the wound moist, and in fact if no antibiotic ointment is available, plain Vaseline will usually work just as well.

Dermabond

Sometimes Dr. Chu uses a liquid bandage called Dermabond.  This is a special skin glue that is used to hold the skin together. Keep this area clean and dry.

Avoid getting the area wet for at least five to seven days. The skin glue will come off slowly, and the edges may need to be trimmed, but do NOT pull or rub off the skin glue.

Bandages

It is usually not necessary to bandage most wounds except

• At night when the ointment might be wiped off on the sheets
• If a child is likely to pick at the stitches
• If there is a high chance of contamination with dirt.  On the other hand, there is no harm in covering wounds (if you prefer), but the wound must still be kept moist with ointment at all times.  A simple “Band-Aid” can be used, or any other clean covering that is easy to use.

Cleaning of Wounds

Although it is a good idea to keep large amounts of contaminated water out of the wound, it is generally okay to allow clean shower water to wash over the wound as long as no scrubbing is performed. 

The wound may be additionally cleaned lightly once or twice a day. If crusts, mucous or blood accumulate, a good way to remove these is with the gentle applications of hydrogen peroxide on Q-Tips, or lightly dabbing with clean gauze.  The hydrogen peroxide will loosen the crusts and allow easy removal with little rubbing. 

After the wounds are cleaned, of course it is important to recover them with antibiotic ointment.

Wound Infection

Wound infection is relatively unlikely in the face or scalp because the blood supply of these areas is so good.  However, if a wound infection occurs, you should notify our office. 

Signs of wound infection include large amount of pus coming from the wound, marked progressive swelling around the wound, or a marked increase in redness and tenderness around the wound (although some redness, swelling and bruising are to be expected even without an infection).  Also, a fever over 101ºF would indicate an infection as well.

Suture Removal

Sutures will be usually removed between 5 and 8 days.  If you do not already have an appointment, you should contact our office to arrange for suture removal some time during this period.  After the sutures are removed, it is a good idea to keep the wounds covered with ointment for approximately 2-3 additional days.

Also any areas of scrapes or raw surfaces on the skin should be covered with ointment until the skin has completely covered the surface.

Antibiotics

Antibiotics may be prescribed to help prevent infection of wounds, especially if the wounds have occurred as a result of an injury. If the wounds are the result of planned surgical procedure, antibiotics often are not  necessary.

Pain/Nausea Medications

The surgeon will prescribe appropriate pain medication if needed.  If these include narcotics, such as Tylenol with Codeine or Lortab, use only as much pain medication as is necessary to relieve the pain, as high doses can cause nausea.  If it is necessary to take large doses of pain medications it is probably a good idea to rest while taking these medications because activity combined with narcotics will be more likely to cause nausea.  Also, remember not to drive or operate machinery when you are taking pain medications. 

The surgeon may prescribe a medication for nausea, usually Phenergan. This only needs to be used if you are nauseated either as a result of taking the pain medication, or if you have undergone general anesthesia, which can also cause nausea.  Frequently, nausea medicine is available either as a pill or as a suppository, depending on what is appropriate for the patient and the patient’s preference.

Wound Healing

After the stitches are removed, the wound still has a long way to go to become completely healed. The scar can take as much as one year or longer to completely reach its final stage.  Initially, the scar will become swollen and over the first month to two months the edges will become firm and possibly elevated.  Also, over this period the area around the scar will turn more reddish in color. This is a normal part of wound healing and should not cause alarm. After the first 2-3 months, the wound will gradually get softer and the red color will gradually fade until the color and texture are similar to the surrounding skin at about a year or slightly more.

During the first year and especially during the first 6-months after a skin wound, it is important to avoid sun exposure (or any kind of tanning booth!)  because it could cause the scar to have a darker color than the surrounding skin that might be permanent.  So wear a hat and/or use sunscreen whenever exposed to sunlight (SPF 25 or greater). 

Several factors affect the way a wound heals and the scar that forms as a result of this. Younger individuals have very strong wound healing and, consequently, tend to form scars that are thicker and may be more noticeable than older individuals. Specifically, children and young adults fall into this category. Individuals over about 30 have more favorable wound healing in that they are less noticeable early on.  If a wound has been created as a result of an injury, frequently the skin edges have been crushed and this makes a somewhat less desirable scar than if the skin had been cut with a knife. Finally, if the skin was injured and cut at an angle (known as a “Trap Door” laceration) this may result in healing up on one edge of wound when the scar heals and contracts.

Scar Revision

If a scar on the face is not cosmetically acceptable, it is frequently possible to improve a scar to a variety of techniques collectively known as a scar revision. While it is not ever possible to completely “remove” a scar, there are a variety of techniques available to make a bad scar much less noticeable. 

In most cases these techniques should be employed after and initial injury had had a chance to completely heal, usually 3-6 months.  These include excising the scar if it was an injury, and closing it with a cleaner incision. Sometimes it is appropriate to irregularize the scar using techniques such as Z-Plasty to change the scar from a straight line which easily catches the eye, to a series of shorter lines at different angles that are not as easily detected from a distance. 

Lastly, a commonly used technique is dermabrasion, or skin sanding.  This helps to smooth out and blend the contours of a scar. Dermabrasion may be carried out in stages and may consist of one or a combination of these techniques.