Forehead Lacerations: Healing, Complications, and Care

Forehead laceration

Hello, around early April, I was hit on the forehead by a softball, resulting in a laceration of about five centimeters.
I went to the emergency department at Taoyuan Min-Sheng Hospital, where the emergency physician performed a CT scan to rule out a concussion.
After that, I underwent a suturing procedure with both internal and external layers.
I was then referred to the plastic surgery department.
When I returned for a follow-up a week later, the plastic surgeon mentioned that the emergency physician had sutured too tightly, causing my wound to have difficulty swelling down.
They removed one of the stitches to allow the accumulated blood to drain.
Another week later, I had the stitches removed, but when I got home, I noticed that two ends of the internal stitches were left outside: one was a complete stitch, and the other was stuck to the area where the outer layer had healed.
Is this normal? The two parts of the stitches are white; they should be absorbable sutures, right? How long should it take for them to dissolve? Currently, the wound occasionally has a stabbing sensation.
Are all these phenomena normal, doctor? Thank you.

Luo Lujian, 30~39 year old female. Ask Date: 2016/05/07

Dr. Zhou Hongzhang reply Plastic Surgery

1.
The inner sutures are typically absorbable sutures, and their color may vary.
2.
It is common for the wound to experience occasional sharp pain, which is a typical phenomenon after an injury and should improve over time.

Reply Date: 2016/05/07

More Info

Hello! Thank you for sharing your experience regarding your forehead laceration. It sounds like you've been through quite a lot since the injury, and I appreciate your detailed description of the events and your concerns. Let's address your questions and provide some insights into the healing process, potential complications, and care for forehead lacerations.

First, it's important to understand that lacerations on the forehead, especially those that are deep or involve multiple layers of tissue, can be complex. The forehead is a highly vascular area, meaning it has a rich blood supply, which can aid in healing but also lead to complications if not managed properly.

From your description, it seems that you initially received appropriate care, including a CT scan to rule out a concussion and a layered closure of the wound. However, the subsequent issues you faced, such as the tightness of the stitches and the presence of retained suture material, are not uncommon.
1. Tight Stitches and Swelling: It's not unusual for stitches to feel tight, especially if the wound is closed under tension. This can lead to swelling and discomfort. The fact that a plastic surgeon had to intervene to relieve some of the pressure by removing a stitch indicates that the initial closure may have been too tight. It's crucial for stitches to be snug but not overly tight, as this can impede blood flow and healing.

2. Retained Suture Material: The presence of suture material sticking out of the skin is something that can happen, especially with absorbable sutures. If the sutures are made of a material that is meant to dissolve over time (like Vicryl or Monocryl), they typically take a few weeks to months to fully absorb. However, if the ends of the sutures are protruding and causing discomfort, it may be worth discussing with your healthcare provider. They can assess whether the retained suture material needs to be removed or if it can be left to dissolve naturally.

3. Occasional Pain or Discomfort: It's not uncommon to experience occasional sharp or stabbing pains in the area of a healing laceration. This can be due to nerve endings regenerating or the body’s healing process. However, if the pain becomes more frequent or severe, or if you notice any signs of infection (such as increased redness, warmth, swelling, or discharge), you should seek medical attention promptly.

4. Healing Timeline: Generally, superficial lacerations can take about 1-2 weeks to heal, while deeper lacerations may take longer. The initial healing phase involves the formation of a scab, which protects the underlying tissue. After the scab falls off, the skin may still be sensitive and take additional time to regain its normal appearance and sensation.

5. Care Recommendations:
- Keep the area clean and dry. You can gently wash the area with mild soap and water.

- Avoid picking at scabs or any protruding suture material unless advised by a healthcare professional.

- If you experience significant pain, swelling, or any signs of infection, contact your doctor.

- Follow up with your healthcare provider as recommended to ensure proper healing and to address any concerns regarding the retained suture material.

In summary, while some of the symptoms you're experiencing can be normal during the healing process, it's always best to consult with your healthcare provider for personalized advice and to ensure that everything is healing as it should. They can provide the most accurate assessment based on a physical examination and your specific situation. Take care, and I hope you have a smooth recovery!

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