Nose Job

One of the more interesting patients from my last call night came in with a pretty good sized cut in his nose.

The white thing is a Q-tip, holding the flap of nose back so you can appreciate it better.

Said it happened about 4 hours ago, "on the street", but he didn't remember how.  He was still drunk.

I'm kinda thinking he was attacked with a serrated knife, or a broken bottle.  No blunt trauma -- whatever it was was sharp, but it had a few little side cuts to it also.

I've never stitched up something this big on the face before, but I figured it couldn't be more difficult than perineal repairs, so I had the nurse clean it, then I got out some 4-0 vicryl and placed a few deep sutures, then did a running subcuticular stitch with 4-0 prolene.  Some steristrips to hold the ends of the prolene down and to cover the wound, some ibuprofen and Keflex (I don't know the statistics, but nose wounds have GOT to be high risk for infection, right?), and sent him on his way.

He didn't bring much money with him, so he could only buy 3 days worth of Keflex.  So he'll come back and see me on Tuesday, and I'll make sure it looks okay and probably give him a little more Keflex.  Stitches out in a week, then I'll take a last photo.

Update, 4 days later:
Well, he was supposed to come back on day 3, but I suppose day 4 isn't all that bad.
I took out the prolene subcutaneous stitch today.  (Was gonna wait until day 7 but it was a twisty enough route that I was worried about whether I'd be able to pull it after all that time.)

I think it looks alright.  I cleaned it again, replaced the steristrips, and gave him more Keflex.  He still says he has no idea how this happened, but he doesn't really like to meet my gaze.  Definitely embarrassed.  Is here with his dad, as he was the first time.  He's supposed to come back again in 3-5 days.