Successful Debridement & Suturing of Forehead Laceration in a Baby

Chief Complaints

A 1-year-5-month-old baby girl presented to the Plastic and Reconstructive Surgery Department at PACE Hospitals, Hitech City, Hyderabad, with an alleged history of injury to the left forehead following an accidental fall at home. On evaluation, there was no history of loss of consciousness, seizures, vomiting, or ENT bleeding. There was also no history of any other associated injuries.

The patient had no known past medical history and no prior history of chronic illnesses, hospitalisations, or surgeries. There were no known allergies, and her developmental history was reported to be appropriate for her age.

On examination, the child was conscious, coherent and oriented. There were no signs of pallor, cyanosis, clubbing, lymphadenopathy, or pedal edema. Systemic examination was otherwise unremarkable, with stable vital parameters and adequate oxygen saturation on room air.

Following the clinical examination, the Plastic and Reconstructive Surgery team conducted a thorough assessment, including a detailed review of the patient’s medical history and presenting complaints of injury to the left forehead following an accidental fall at home, with no associated history of loss of consciousness, seizures, vomiting, ENT bleeding, or other injuries.

A focused local examination of the forehead was performed to assess the extent of the wound. Relevant clinical parameters were evaluated to rule out associated systemic or neurological involvement. The assessment primarily focused on identifying the depth of the laceration, presence of contamination, tissue viability, and any signs of active bleeding or underlying structural injury.

To confirm the diagnosis and determine the extent of tissue involvement, the affected area was carefully examined. The evaluation revealed a left forehead laceration without evidence of foreign body involvement or associated complications.

Based on the confirmed diagnosis, the patient was advised to undergo Left Forehead Laceration Treatment in Hyderabad, India, under the Plastic and Reconstructive Surgery team to remove devitalized tissue, prevent infection, promote optimal wound healing, and achieve a favorable cosmetic outcome.

After a detailed consultation with Dr. Kantamneni Lakshmi, Senior Consultant Plastic, Reconstructive & Aesthetic Surgeon, a comprehensive evaluation was performed to determine the most appropriate diagnostic and therapeutic approach. Considering the patient’s history of injury to the left forehead following an accidental fall, with no associated loss of consciousness, seizures, vomiting, ENT bleeding, or other injuries, a focused local examination of the forehead was undertaken to assess the extent of the laceration, tissue involvement, and presence of contamination or devitalized tissue. Clinical findings were suggestive of a clean laceration over the left forehead without evidence of deeper structural or neurological involvement.

Based on the clinical findings, which confirmed a left forehead laceration, it was determined that debridement and suturing under general anesthesia was identified as the most suitable intervention to remove devitalized tissue, achieve adequate wound cleansing, ensure proper wound closure, prevent infection, and promote optimal healing with a favorable cosmetic outcome, particularly considering the patient’s young age and the location of the injury.

The patient’s family members were thoroughly counselled regarding the diagnosis, need for the procedure, details of surgical management, potential risks, and expected recovery. Informed consent was obtained, ensuring their understanding and active participation in the treatment plan.

Following the diagnosis, the patient was scheduled to undergo Debridement and Suturing Procedure in Hyderabad at PACE Hospitals, under the supervision of the expert Plastic and Reconstructive Surgery team.

The surgical procedure involved the following steps:

• Anaesthesia and Patient Preparation: The patient was taken to the operating room and placed under general anesthesia. After ensuring adequate anesthesia, the patient was positioned appropriately. The surgical site over the forehead was prepared under strict aseptic precautions, painted with antiseptic solution, and draped to maintain a sterile field.

• Wound Assessment and Debridement: A thorough inspection of the forehead laceration was performed to assess the extent of tissue injury. All devitalized, contaminated, and non-viable tissue was carefully debrided to create clean wound margins, which is essential for preventing infection and promoting optimal healing.

• Wound Irrigation (Wash): The wound was copiously irrigated with sterile solution to remove debris, contaminants, and reduce bacterial load. Proper wound cleansing was ensured to minimize the risk of postoperative infection and prepare the site for closure.

• Layered Wound Closure: The wound was closed in two layers to restore anatomical integrity. The deeper layer was approximated using absorbable sutures (5-0 Vicryl) to provide strength and support, followed by precise skin closure using finer sutures (6-0 Rapide Vicryl) to achieve good cosmetic results and minimize scarring.

• Hemostasis and Dressing: Hemostasis was secured throughout the procedure to prevent bleeding. After confirming adequate closure and absence of active bleeding, a sterile aseptic dressing was applied over the wound. The procedure was completed without any complications, and the patient tolerated it well.

The postoperative period was uneventful, and the patient recovered well following debridement and suturing of the left forehead laceration. During the hospital stay, she received appropriate care for infection prevention, pain control, gastric protection, and supportive postoperative management. The patient remained clinically stable throughout the hospital course with satisfactory wound condition and no complications. She was discharged in a stable condition with follow-up instructions.

Upon discharge, the patient was prescribed medications to prevent wound infection, support stomach protection, and manage pain and fever. Infection prevention therapy was advised to reduce the risk of postoperative complications, along with stomach protection to prevent irritation during recovery. Medicines for pain and fever control were provided to ensure comfort and aid healing. The caregivers were instructed to administer all medications as directed and complete the prescribed course for optimal recovery.

The patient was advised to resume a normal diet as tolerated. Caregivers were instructed to maintain head end elevation to reduce swelling and support recovery. Proper wound care with regular sterile dressing changes and maintenance of hygiene at the surgical site was emphasized. In case of any altered consciousness or unusual neurological symptoms, prompt neurosurgical evaluation was advised for further assessment and management.

The patient was informed to contact the emergency ward at PACE Hospitals in case of any emergency or development of symptoms like fever, increasing pain, swelling or discharge from the wound, or any signs of altered consciousness. 

The patient was advised to return for a follow-up consultation with the Consultant Plastic, Reconstructive & Aesthetic Surgeon in Hyderabad at PACE Hospitals after 2 days. 

This case highlights a left forehead laceration following accidental trauma, managed with timely surgical debridement and layered suturing under general anesthesia. The intervention ensured effective wound cleaning, infection prevention, and optimal healing. The postoperative period was uneventful with stable recovery and good wound outcome. The case emphasizes the importance of early surgical care and proper follow-up in pediatric facial injuries.