Commentor Question: Lacerations and Plastic Surgeons

This blog is generated from a comment on this post: Medical Myth: Lacerations Need a Plastic Surgeon.

I do read each and every comment to the blog. Usually, I don’t comment on real life medical scenarios but I thought this had several good teaching points that could serve the public good.

The comment:

I just brought my 5 y/o into an ED with a puncture wound to the center of his forehead through which you could see his skull. I thought the attending would close the wound, but the resident did under supervision. First year, and it was late July. What are the chances of a good outcome? The attending had to tell the resident that knots were backward, etc. Should I have insisted that the attending close, or that they call plastics? It was a large urban Children’s ER.

Jordyn Says:

Thanks so much for leaving this comment and I hope you see this post.

As a mother and a nurse, I get the parental anxiety around closing lacerations. The truth is that anything that requires sutures is going to leave a scar. That’s life. Now, how big or thick the scar is depends on many factors. How it was closed. There is a learning curve to closing the skin. Lacerations can actually be closed too tightly which can be as problematic as not bringing the edges close enough together.

That being said, there are many other factors that determine how the scar will look. Does it become infected? How does the patient normally scar? Some people genetically develop very heavy scarring (called keloid scarring) and there’s nothing we can really do about that. Also, after healing, how much is it exposed to the sun?

Now, should you have allowed a resident to suture your child?

From the medical side– students need to learn and must practice, at some point, on live patients. I’m glad this first year was being monitored during the procedure. That’s what should have happened. Knots being tied backwards and needing to be redone doesn’t mean you’ll have a bad outcome. Experienced physicians redo sutures all the time. It’s more the final closure that’s important.

From my nursing/mother standpoint– you have the right to refuse a resident practicing on your child. If you are uncomfortable then absolutely speak up and state your request plainly– “I’m sorry, but I’d like an attending to close this laceration.”

Some people are uncomfortable with a nurse practitioner or physician’s assistant doing a laceration repair and request an attending. Keep in mind, that mid-level provider may have more experience than your attending physician. They may have been in practice four times as long! So maybe ask how many years they’ve been practicing as an attending before you pass over on a mid-level provider.

If you feel that you can’t make this request to the doctor directly, then you need to tell your nurse who should advocate for you.

Should you have insisted on a plastic surgeon? The truth is that pediatric ER providers close lacerations every day on moving targets— we don’t commonly sedate kids for simple laceration repairs. Plastic surgeons are generally only utilized for complex laceration repairs and would honestly be annoyed to come to the ER for a simple repair.

If you don’t like how the wound healed and the scar it left behind then you can consult a plastic surgeon to investigate a scar revision.

Hope this helps.

Author Question: Fire Extinguiser Versus Face

Theresa S. asks:

While fighting off an attacker, my MC strikes him across the face with a fire extinguisher canister. She’s shorter than him, so the swing would be upward, and it struck him (on, near, around) the
cheekbone. I imagine this could create a gash, yes? And if it did, what do you think the gash would look like?

He will not visit a hospital (so he won’t get stitches), but instead will have a friend “patch it up” which, I’m not quite sure what that will entail.

Jordyn Says:

Hi Theresa,

Thanks so much for sending me your question.

Yes, this type of injury could easily cause a laceration to the cheek. In my experience, it would be a linear or straight cut of varying size maybe at the largest 1-2 inches. He also has the possibility of facial fractures (after all, those things are big and heavy) and a chance of traumatic brain injury as well (something along the lines of a concussion.)

The best way to get a cut “patched up” as you say is to use butterfly closures but many people do not know how to apply them correctly. A sticky end of two pieces should be applied on either side of the cut, then the edges drawn together, and then opposing sides taped down. Almost like you’re pushing the ends of a box together.

Here’s a video that covers how to apply butterfly closures but it doesn’t use my technique which I do find more effective.

Hope this helps and happy writing.


Theresa Santy recently won the FaithWriters Page Turner Contest for her novel-in-progress. She has a passion for writing but also loves Jesus, family and friends, laughter, and flip-flops. Learn more about Theresa @