Tailored versus conventional surgical debridement in complex facial lacerations in emergency department: a retrospective study

Abstract

Abstract Background Surgical debridement is usually an essential step in treating complex facial lacerations (CFL). As the severity of CFL increases, conventional surgical debridement (CSD) of wound edges becomes difficult and may be insufficient to remove damaged tissues and create clean edges. Because the severity and shape of CFL are diverse and different, it is necessary to tailor the customized pre-excisional design, the tailored surgical debridement (TSD), for each case before performing surgical debridement. Applying TSD is expected to enable effective debridement in CFL with higher severity. This study compared cosmetic outcomes and complication incidence of CSD and TSD, according to CFL severity. Methods This was a retrospective observational study. Eligible patients with CFL who visited the emergency department between August 2020 and December 2021 were examined. CFL severity was graded to Grades I and II. CSD and TSD outcomes were compared using the Scar Cosmesis Assessment and Rating (SCAR) scale. Furthermore, a good cosmetic outcome was defined as a SCAR score of ≤ 2. The percentage of good cosmetic outcome between the two groups was compared. The SCAR score and percentage of good cosmetic outcomes between the two groups were compared overall and by severity. For comparison of complication incidence, asymmetry, infection, and dehiscence incidence were compared. Results In total, 252 patients were enrolled (121 [48.0%] CSD and 131 [52.0%] TSD). In CSD and TSD groups, the median SCAR scores were 3 (1–5) and 1 (0–2) in all enrolled patients (p < 0.001), 2 (0–4) and 1 (0–1) in Grade I (p < 0.01), and 5 (4–6) and 1 (1–2) in Grade II (p < 0.001). The good cosmetic outcomes were 46.3% and 84.0% overall (p < 0.001), 59.6% and 85.0% in Grade I (p < 0.01), and 9.4% and 83.5% in Grade II (p < 0.001) for CSD and TSD. The incidence of complications was significantly higher in the CSD than in the TSD groups, but this was limited to asymmetry. There was no statistical difference in both infection and dehiscence. Conclusion TSD can lead to an objectively good cosmetic prognosis at higher CFL severity than CSD and can reduce the occurrence of facial asymmetry.