Facial lacerations are common and are caused by a variety of mechanisms. One well known cause is that of dog bites, particularly in children. Their smaller size and natural lack of caution around animals can create unfortunate opportunities for such accidents to occur. Children are particularly prone to dogbite injuries to the face. Canine (dog) teeth frequently engage soft tissues leaving a trail of injury as the child’s face pulls back…albeit too late.
This unfortunate young female child sustained a dog bite injury to the face with an obliquely oriented deep laceration across the upper forehead. The laceration went down to the bone through the frontalis muscle resulting in a large soft tissue flap. It was impossible to determine at the lower end of the laceration closer to the temple whether the frontal branch of the facial nerve was injured or not.
A meticulous multilayer closure was done, finalizing with a 6-0 plain suture closure for the skin. (taking sutures out in young children is not a good experience for the child) As always occurs putting the tissues back together changes a horrendous looking wound into a more acceptable appearance that is more optimistic about the eventual outcome when it is fully healed and mature.
Traumatic laceration repairs can have good scar outcomes with a multilayer closure with meticulous attention to skin realignment. But like all lacerations repairs it is best to anticipate that a scar revision may eventually be needed after awaiting time for the scar to heal and fully mature.
Dr. Barry Eppley