Irrigation, debridement, and complex repair of stellate laceration on the forehead. Total length of repair, approximately 1.8 cm.

PREOPERATIVE DIAGNOSIS:  Stellate laceration to the forehead.

POSTOPERATIVE DIAGNOSIS:  Stellate laceration to the forehead.

PROCEDURE:  Irrigation, debridement, and complex repair of stellate laceration on the forehead.  Total length of repair, approximately 1.8 cm.

ANESTHESIA:  A 1% lidocaine with epinephrine.

COMPLICATIONS:  None.

INDICATIONS FOR SURGERY:  This patient is a 46-year-old white male who was leading a meeting and turned suddenly and struck his face on a door.  He sustained a laceration to the forehead and also bumped his nose and his knee.  He presented to the Emergency Room for evaluation and had requested a plastic surgical consultation.  The patient denies any loss of consciousness.  Denies any other injuries.  He has no difficulty breathing through his nose and had a little bit of a bloody nose afterwards.  He is up-to-date with immunizations.  He denies any significant past medical history.  Examination reveals the patient in no acute distress.  He is alert and oriented x3.  He has a stellate-type laceration with multiple flap components in the mid-forehead, measuring a total length of approximately 1.8 cm.  The skin edges are irregular.  The skin laceration is beveled and extends into the subcutaneous tissue.  Extraocular movements are intact.  Vision is grossly normal.  There is no maxillary or periorbital tenderness.  Occlusal opening and closing is normal.  He does have some contusional changes along the dorsum of his nose with some mild tenderness.  The nasal bones do appear to be midline, although he does have a slightly deviated septum, which appears chronic.  There is no septal hematoma.  I discussed the findings with the patient.  The patient requests repair of the stellate laceration.  In regards to the nose, at this time we will not perform any nasal x-ray since it really would not help with his treatment.  The bones do appear midline, but we will wait until we reevaluate the patient on Friday.  If the nose does appear to be deviated, we will obtain x-rays.  Otherwise, the patient would prefer to treat it conservatively and try to avoid surgery.  The potential risks and complications of the surgical procedure were thoroughly discussed with him and included, but are not limited to bleeding, infection, scarring, asymmetry, deformity, recurrence, problems with healing, hypo or hyperpigmentation, hypertrophic or keloid scarring, widening of the scar, and the need for further surgery.  He is fully informed that there will be scars, scars are permanent, and no guarantees can be given as to the final outcome, appearance, location, or length of the scars.  The patient states he understands.  All of his questions were answered and he gives consent.

PROCEDURE IN DETAIL:                                    The patient was placed in a supine position, where the area was prepped and draped using sterile technique.  The wound was infiltrated with 1% lidocaine with epinephrine.  The wound was explored.  No foreign material was noted.  Conservative debridement of the skin edges was performed in order to allow better approximation of the tissues.  After thorough irrigation, the tissues were approximated using multiple interrupted buried 5-0 Vicryl sutures to approximate the subcutaneous tissue and dermis, followed by 5-0 Monocryl in a subcuticular fashion.  Dermabond was then applied and once dry, Mastisol and Steri-Strips.  Total length of repair was approximately 1.8 cm.  The patient tolerated the procedure well and was given instructions in regards to care.  Informed to call the office tomorrow for a followup appointment on Friday and states he understands all of the instructions.