Current Management of Facial Wounds in UK Accident and Emergency Departments

Abstract

A 16-year-old male with a simple but dirty wound over the right cheek. B 23-year-old female with a complex wound to the lower lip. C 65-year-old male with an extensive laceration to the forehead. RESULTS There was a 76% response rate. Suturing was the preferred method of closure, with the majority of clinicians preferring 6/0 or 5/0 non-resorbable sutures. Use of a regional nerve block would be considered by a quarter of clinicians, and adrenaline vasoconstrictor by a third. Referral rates ranged from 5-77% for a more complex wound. Maxillofacial services were preferred by 51% of respondents; on-site referral availability was indicated by only 28%, with an average journey of 16 miles for treatment. Up to 30% of clinicians considered prescribing antibiotics after wound closure, with flucloxacillin and co-amoxiclav most commonly suggested. Accident and emergency review rates ranged from 16% to 45%, with most wounds either being referred to the GP or no formal review being suggested. EMERGENCYCONCLUSIONS The results of this survey suggest that there is considerable variation in the initial management, referral and review of facial wounds in the UK. Further work is required to formulate guidelines for optimal patient care, ideally in conjuncture with the receiving surgical specialties.

Satisfaction with facial laceration repair by provider specialty in the emergency department

“…In the present study’s results, 71.7% of simple facial lacerations were repaired by an ED resident ( Table 1 ). In the UK, 50% to 90% of simple facial lacerations are repaired by accident and ED doctors; the rest of them are referred to other specialists [ 2 , 12 , 13 ].…”

Early Complications Following Facial Laceration Repair Performed by Emergency Physicians After One Year of Wound Closure Training

“…A propensity score was developed using logistic regression to estimate the probability of being assigned to the participant group compared with the nonparticipant group. Relevant covariates were identified from known risk factors for wound complications and precision of discrimination and propensity score calibration were analyzed using the c‐statistic and Hosmer‐Lemeshow goodness‐of‐fit test. Matching was not performed using provider status because all the wounds were repaired by a pair of physicians (an intern with a board‐certified emergency physician or a resident with a board‐certified emergency physician) and board‐certified emergency physicians were always involved in wound closure, as well as because unmeasurable differences in suturing skills among each provider status would potentially exist.…”

“…Although patients may prefer facial trauma specialists, such as plastic surgeons, oral and maxillofacial surgeons, or otolaryngology/head and neck surgeons, to close their facial wounds to obtain the best possible outcome, the distribution of facial trauma coverage by specialists at the ED is regionally dependent . Studies have shown that a considerable number of facial wounds were repaired by nonspecialists, including emergency physicians, general surgeons, and registered nurses . A 2015 retrospective observational study of patients with facial lacerations found that more than 70% of patients underwent repair by a nonspecialist .…”

“…Facial trauma nonspecialists have no available standard protocols regarding the management of facial lacerations, and patterns of patient referral to specialty services are also reported to vary, according to physician preferences and protocols between different institutions . In 2006, a survey regarding the management of facial lacerations by emergency physicians identified a considerable variety of practices including wound closure methods, preferred suture material, antibiotic therapies, and specialist referral . In another survey within the United States, only 61% of emergency or trauma services at teaching hospitals claimed to have a protocol in place for referral of patients with facial injuries .…”

Is this the end of the Oral and Maxillofacial Toolbox? A retrospective analysis of funding for acute OMFS soft tissue trauma provision within the UK

“…3 The analysis shows there are clear financial implications to this outdated model and coding arrangements, 4 especially as the service model is commonplace within OMFS units across the UK. 5 We have proposed and costed an alternative service model, similar to other acute surgical specialities, where patients return to the treating department when safe to do so as part of a scheduled trauma list (often run daily by a trainee with additional senior support available). Such trauma lists can also maximise use of re-usable instrument trays which are sterilised through theatre services, minimising single use item waste to reduce cost and become more sustainable.…”