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Accidents

Chapter Five Accidents Emergency Care Minimizing Scarring Scar Repair Excision Scar Transformation Dermabrasion

SAD TO SAY, accidents, especially motor vehicle accidents, provide most facial cosmetic surgeons with a steady stream of customers. Many years ago, I did some research and prepared a paper for a medical publication on the subject of facial injuries. It was ground-breaking news at the time, but I found a direct link between the number of patients I saw with severe facial fractures and those who confessed that they were not using a seat belt at the time of the accident.

An insurance company picked up on the story, and on January 1, 1976, the Province of Ontario became the first major North American jurisdiction to enact legislation for the compulsory use of seat-belt restraints. Concurrent legislation was enacted to reduce highway speed limits. My earlier research focused primarily on bony injuries; with Dr. John D. Keohane, I have since done further research into soft tissue injuries, and in February 1991 we published a paper on trauma assessment and scar revision.

I am pleased to say that nowadays we see fewer patients with injuries from windshields and the like. But accidents do happen, and this chapter is about the sorts of things that we do to repair such injuries, with special emphasis on the techniques we use to repair soft tissue or facial skin scars.

Most wounds inflected on facial soft tissues are minor; and they heal quickly without much lasting effect. This is partly because the face regenerates skin faster than anyplace else on the body. It’s also because the face is flessed with a rich supply of oxygen-bearing blood from two major arteries located on either side of the head; we call them the internal and external carotid arteries.

The internal carotid artery supplies blood to the brain and its coverings, as well as the eye and its orbital contents. But the primary supply of blood comes from the external artery, which is connected to a network that feeds the face, neck and scalp. Both the internal and external arteries have hundreds of tiny capillary connections so that facial wounds are likely to bleed more vigorously than cuts to other parts of the body. The bounty of blood also means that the chances of having a facial wound become infected at considerably lower than the chances of infection in wounds anywhere else.

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