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Provider Prepared's Weekly Pearl of Wound Wisdom # 34 Infraorbital how to 0

For anesthesia of the medial cheek, lateral nose, upper lip and lower eye lid, infraorbital nerve block is appropriate. We recommend the intra-oral approach for infraorbital nerve blocks.

Landmarks for the nerve block are: the second bicuspid, the pupil with a straight forward gaze and the inferior bony otrbit notch. The infraorbital foramen is located in the mid portion of the zygomatic arch, inline with these landmarks, and frequently can be palpated.

For an intraoral approach; insert a 27 or 25 gauge needle through the gum line, oriented in line with these landmarks at the second bicuspid, directed toward the infraorbital foramen. Keep a finger at the infraorbital foramen, when the pressure of the needle is palpated stop advancing the needle. If the patient develops paresthesia withdraw the needle a short distance until paresthesia resolves. Inject 1-2 mL of anesthestic in to this area.

Hollander, JU et al. Assessment and management of facial lacerations. UpToDate November 2017.

Provider Prepared Laceration Repair Kits with Lidocaine will have you prepared at home and on the go for facial laceration anesthesia and repair.

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Nathan Whittaker, MD

Provider Prepared's Weekly Pearl of Wound Wisdom #33 Facial Anesthesia 0

An important part of facial wound management is achieving appropriate anesthesia for wound repair. Injection of local anesthesia can cause distortion of the tissue, leading to increased difficulty in careful cosmetic repair.

Regional facial nerve blocks are a very useful alternative to local anesthesia. There are three facial nerve blocks that are frequently used for facial lacerations. Mental nerve block, infraorbital nerve block and supraorbital nerve block.

The Mental nerve block provides anesthesia for the lower lip, skin inferior to the lower lip and chin.

Infraorbital nerve blocks anesthetize the upper lip, lateral nose, lower eyelid and medial cheek.

The supraorbital nerve block is useful for anesthesia of the forehead and anterior scalp.

Hollander, JU et al. Assessment and management of facial lacerations. UpToDate November 2017.

Provider Prepared has lidocaine as an option for your Laceration Repair Kits! You can be prepared with all the tools of the trade at home or on the go.

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Nathan Whittaker, MD

Provider Prepared's Weekly Pearl of Wound Wisdom #32 Smashing! 0

A 50 year old male presents to the Emergency Department after smashing his left thumb with a sledge hammer. He has increasing pressure like pain associated with increasing subungual hematoma.

Pain associated with a subungual hematoma is caused by pressure building in a contained space between the nail bed and the nail plate.

Trephination is indicated for the relief of pressure and thus pain of a  subungual hematoma; when the injury is less than 24-48 hours old, is not draining spontaneously, and has intact nail folds. Trephination can be accomplished with electrocautery devices or with the boring technique using a needle. Use of a heated paperclip is discouraged, many paperclips are now made of materials that are not capable of retaining sufficient heat for trephination.                                           Fastle, RE et al. Subungual hematoma. UpToDate  December 2016.

Provider Prepared's Laceration Repair Kits come with a selection of needles that allow you to perform the boring technique at home. Check out our smashing options for honest and affordable wound care at home and on the go.

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Nathan Whittaker, MD

Provider Prepared’s Weekly Pearl of Wound Wisdom #31 Its Cheeky! 0

A 40 year old male presents to the emergency department for evaluation of a cheek laceration, which occurred when he was struck in the face by a piece of aluminum rain gutter while doing exterior finish work on a home he is building.  

As with all facial lacerations, cheek lacerations should have careful examination. When deep tissues of the cheek are involved, examination must include assessment for injury to the parotid gland, parotid duct and facial nerve.

The anatomy of the deep structures of the cheek must be understood for proper evaluation. The parotid gland and facial nerve branches are just anterior to the ear, they are also superficial to the masseter muscle. Since these structures are superficial to the masseter muscle, they can easily be involved in lacerations of the cheek. The parotid duct extends from the gland to the intra-oral mucosa with the opening adjacent to the second molar. Parotid duct injury must be considered when deep tissue laceration is present. Injury to these deep structures requires specialty consultation.

Hollander, JU et al. Assessment and management of facial lacerations. UpToDate November 2017.

This patient was found to have wound extension into the parotid gland, we subsequently  obtained consultation with our Maxilofacial Surgeon, who took the patient to the operating room.

Visit Provider Prepared for honest and affordable wound care at home and on the go!

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Nathan Whittaker, MD

Provider Prepared's Weekly Pearl of Wound Wisdom #30 Knowing the Nose 0

   A 30-year-old male presents to the emergency department with laceration to the left side of his nose after being involved in a mountain bike accident. On evaluation there is no extension of the laceration into any of the cartilaginous structures.  With soft tissue involvement only the wound is appropriate for repair without the need for specialty consultation.

   Lacerations to the nose that involve the entrance of the nare require special attention.  The alar margins should be used as a guide to ensure proper alignment.  Suturing should be done using 6–0 nonabsorbable suturing material in a simple interrupted fashion.  The curvature of the nose must be taken into consideration as the wound is carefully repaired to achieve appropriate shape and alignment.  Exposed cartilage should be appropriately covered with reapproximation of the overlying tissue to ensure no development of infection.  Lacerations involving the mucosal surfaces should be closed using absorbable suture.

Hollander, JU et al. Assessment and management of facial lacertions. UpToDate November 2017.

   Visit Provider Prepared to keep your nose clean and repaired with honesty and integrity, using our affordable laceration repair kits!

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Nathan Whittaker, MD

Provider Prepared's Weekly Pearl of Wound Wisdom #29 Lip Smacking Good! 0

   Lip anatomy consists of the mucosal surface within the mouth, the middle orbicularis oris muscle, the wet vermillion (intraoral) and the dry vermillion (extraoral). These anatomical layers make the lip a very unique structure that requires special attention for wound management. The outline of the lip where vermillion meets the facial skin is called the vermillion border. The vermillion border is a point of cosmetic light reflection, this necessitates precise alignment to prevent a noticeable scar.

   When the vermillion border is involved in a lip laceration, the first stitch should placed at the vermillion border, achieving perfect cosmetic alignment of the border. Nonabsorbable 5-0 or 6-0 suture should be used. 

   Superficial wet vermillion lacerations that are not gaping, less than 2 cm and without oozing of blood do not require repair. Wounds that are gaping, with bleeding and greater than 2 cm do require repair. This repair should be completed with buried absorbable 5-0 or 6-0 suture.

   Lacerations of the dry vermillion should be closed similarly with simple interrupted sutures, when the wound extends into submucosal tissue with no vermillion border involvement.

Hollander, JU et al. Assessment and management of lip lacerations. UpToDate November 2017.

See all the lip smacking wound care goodness Provider Prepared has to offer for wound care at home and on the go!

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Nathan Whittaker, MD