Soft tissue injuries of the head and neck are usually caused by blunt or penetrating trauma and require careful clinical assessment. Imaging may be required to rule out fractures and other complications. Initial management of all head and neck injuries follows the Advanced Trauma Life Support (ATLS) protocol and includes addressing life-threatening conditions, such as airway compromise and bleeding. Once initial management has been concluded and complications have been ruled out, open head and neck wounds are managed similarly to other acute open wounds.
Follow the head injury.in any patient with suspected severe
Significant trauma 
- Ensure dislocations are excluded. until or
- Anticipate the need for . 
- Assess for and begin .
- Evaluate for and perform or as clinically indicated.
- Assess for ear injuries. and
Open wounds 
- Begin (e.g., apply pressure dressing to scalp wounds, ).
- Assess for embedded foreign bodies and associated injuries.
- Consult a specialist prior to wound closure for:
- Provide .
- Consider additional as clinically indicated.
- Provide and consider ice packs to treat swelling.
- Manage associated injuries (e.g., replantation of , reduction of ).
- Control any active bleeding.
- Begin with local pressure and local anesthetic with epinephrine. 
- Consider placing one or two superficial venous bleeding or bleeding from a retracted vessel. over
- Consider clamping and ligating larger (> 2 mm), well-visualized vessels using fine-point hemostats and 5-0 absorbable sutures.
- Reserve electrocautery for injured blood vessels with uncontrolled bleeding.
- Use large-volume normal saline (0.5–1 L) for grossly contaminated wounds.
- Avoid antiseptic solutions (e.g., chlorhexidine).
- Manually remove any residual foreign bodies.
- Embedded particulate matter : Gently scrub the wound with a sponge or surgical brush after applying topical anesthesia.
- Limit tissue debridement to obviously nonviable tissue.
Anesthesia and supportive care
- Administer .
- Consider to minimize distortion of wound edges.
- For children: Consider or .
- Administer and as indicated.
- Abrasions can be treated with a thin layer of antibiotic ointment.
- Consider superficial lacerations. for small
- For nongaping wounds, use a single layer of nonabsorbable sutures.
- For gaping wounds (i.e., deeper than the dermis), perform layered closure.
- Consider contaminated wounds or wounds older than 12 hours.  for grossly
- See also “Closure of acute open wounds.”
- Nonabsorbable facial sutures are typically removed after 3–5 days.
- See also “Follow-up” in “ .”
Eyebrow lacerations 
- Examine sensory functions of the supraorbital and supratrochlear nerves. 
- Perform layered wound closure.
Do not shave eyebrows, as eyebrow hair is an important landmark for correct reapproximation and regrowth is unpredictable. 
Cheek lacerations 
- Consult a specialist in the presence of complications, e.g.:
- and/or injury
- If no complications are present, proceed with wound closure:
Open wounds of the mouth 
- Consult plastic surgery, ENT, oral maxillofacial surgery, and/or dentistry if any of the following are present:
- If missing or chipped teeth: Evaluate wounds for embedded tooth fragments (by inspection, probing, and/or soft-tissue x-ray).
- If no complications, proceed with wound closure.
Lip lacerations 
- Mark the local anesthesia. prior to infiltrating
- Repair involved muscle with multiple layers to optimize cosmetic outcomes.
- Align the vermilion border with a single stitch using a nonabsorbable suture.
- Close the oral mucosa and with absorbable sutures.
Do not use lacerations.  to repair lip
Oral mucosa and tongue lacerations 
- Close deep or gaping tongue lacerations with nonabsorbable sutures.
- For through-and-through oral lacerations:
Other anatomic locations 
- Nasal lacerations
- Forehead lacerations: Treat as any other facial wound.
- Eyelid lacerations: See “Traumatic eye injuries.”
- Ear lacerations: See “Ear injuries.”
General measures 
- Prioritize hemostatic control for actively bleeding lacerations.
- Consult neurosurgery if there is evidence of galea disruption and/or a skull fracture.
- Do not routinely shave the scalp prior to wound repair. 
- For uncomplicated lacerations, perform primary wound closure with staples, sutures, or . 
Hair apposition technique 
- Definition: a technique for primary closure of scalp wounds using strands of hair and tissue adhesive
- Indications: simple, superficial scalp wounds suitable for primary closure in adults and children
- Contraindications: actively bleeding, contaminated, or complex scalp wounds
Procedure: For pitfalls and postprocedural concerns, see also “Tissue adhesive.”
- Grasp several strands of hair from opposite sides of the wound using hemostats or gloved fingers.
- Cross and interlock the strands over the wound with a 180° or 360° twist without knotting the hair.
- Apply a drop of tissue adhesive over the base of the twist and allow it to dry.
- Repeat steps every 1–2 cm along the entire wound.