Soft Tissue

The important message in the management of facial soft tissue injuries is to clean the wound of all debris - a clean toothbrush is often very useful.

What are you trying to achieve with your management of soft tissue injuries?

• Optimal healing with minimal aesthetic or functional deficit
• Avoid worsening situation
• Repair of damaged tissue
• Minimal scarring

Principles of management of facial injuries:

• Assess for other injuries
  • Primary survey
  • Secondary survey
• Clean the wound
  • Clean thoroughly with saline as dirty wounds may tattoo permanently

Contusions and abrasions

A contusion represents an injury to the soft tissues and is associated with tenderness, swelling, and ecchymosis/bruising. The treatment is to apply an ice pack to the affected area. These injuries can be expected to resolve over several days to weeks. Abrasions are partial-thickness losses of skin caused by shearing forces. Adequate cleaning followed by topical antibiotic ointment for one week is usually adequate. They usually progress to scab formation and then fully resolve.

Management of epistaxis

On the field of play, if there is epistaxis a good immediate measure is to insert a dental cotton roll – pre-soaked in dental anaesthetic into each nostril and then keep pressure applied. Keep the head forward as this allows blood to run forwards and out through the nose or mouth. This “buys” a little time in obtaining haemostasis, while getting the injured player to the medical room.

If the bleeding persists despite correctly applied pressure and nasal plugs, then the medical practitioner may consider:

Specialist Nasal balloons e.g. Rapid Rhino® – these need to be inserted into each nostril and then 5-10 mls of water injected into them so that they enlarge ,also use external digital pressure.

If the bleeding is not controlled then referral to an appropriate Emergency Department or on call nasal specialist is required.