Deep Nose Laceration Repair

Initial Assessment and Preparation

The American Academy of Pediatrics recommends applying topical anesthetics such as LET (lidocaine, epinephrine, and tetracaine) to the wound and allowing it to soak for 10-20 minutes or until wound edges appear blanched 1, 2
For deeper lacerations, supplement topical anesthesia with local infiltration using buffered lidocaine, warmed before injection, and injected slowly with a small-gauge needle for minimal pain 1, 2

The Rhinology society recommends identifying and reapproximating any damaged cartilage structures using absorbable sutures, and for septal involvement, repairing the septum first as "the septum goes, so goes the nose" 3, 4
The Rhinology society also recommends using figure-8 sutures to stabilize adjacent cartilage segments and prevent overlap 4
The American College of Obstetricians and Gynecologists recommends reapproximating subcutaneous tissues and muscle layers using continuous, non-locking absorbable sutures, which distributes tension more evenly across the suture line and provides better support 5, 6
For optimal cosmetic results, the American College of Obstetricians and Gynecologists recommends using continuous non-locking subcuticular sutures for skin closure 5, 7

The Rhinology society recommends ensuring proper alignment of nasal cartilage to prevent future deformities, and considering batten-type grafts to reorient and straighten damaged cartilage when necessary 3, 4

The American College of Obstetricians and Gynecologists recommends considering prophylactic antibiotics for deep lacerations, especially those involving cartilage 7

The American College of Obstetricians and Gynecologists recommends monitoring for signs of infection including increasing pain, redness, swelling, or purulent discharge, and considering early follow-up within two weeks to assess wound healing 5, 7
The American College of Obstetricians and Gynecologists also recommends pain control can be achieved with acetaminophen, ibuprofen, and ice packs; opiates should be used only if needed 5, 7