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Vertical forehead lacerations tend to have a more visible scar because they
traverse the skin tension lines. Complex forehead wounds, such as stellate
lacerations from windshield impact and those with tissue loss, particularly
secondary to animal bites, may require consultation with a plastic surgeon.
Forehead lacerations are rarely associated with skull fractures, but facial or
intracranial injuries should be ruled out.

Eyebrow Lacerations
Eyebrow lacerations are common. Repairing an eyebrow laceration is
complicated by the presence of hair. It is advisable not to shave the eyebrow for
wound preparation because it serves as a landmark during repair. Also, eyebrow
regrowth is unpredictable; it may be either slow or incomplete, potentially leading
to poor cosmetic outcome. Debridement, if required, should be minimal and along
the same axis of the hair shafts to avoid damage to hair follicles; otherwise,
alopecia of the brow will result. Closure with simple interrupted stitches using
nonabsorbable material is usually sufficient. Attention must be paid to avoid
inverting the hair-bearing edges into the wound. It is also important to pay
attention to proper alignment of both ends of a wound along an eyebrow.

Eyelid Lacerations
Most eyelid lacerations are simple transverse wounds of the upper eyelid just
inferior to the eyebrow. Repairing these wounds does not require any special
skills. Well-approximated lacerations in the transverse crease of the eyelid will
heal well if left alone. However, recognizing complicated eyelid lacerations is
crucial for proper repair and optimal outcome (see Chapter 114 Ocular Trauma ).
Vertical lacerations involving the lid margin require precision in approximation to
avoid deformity and malfunction of the eyelid. Injuries potentially involving the
levator palpebrae muscle, medial canthal ligament, or lacrimal duct should be
considered for ophthalmology referral. A high index of suspicion for lacrimal
duct injury is particularly important when evaluating a medially positioned lower
eyelid laceration. If not repaired, inferior duct injury may lead to chronic tearing

as the lower lacrimal duct is the main drain of tears from the conjunctival sac.
Evaluation for an associated injury of the globe is a must, particularly if
periorbital fat is exposed or tarsal plate penetration is present (see Chapter 114
Ocular Trauma ).

External Ear Blunt Trauma and Lacerations
Although the ears are subject to trauma because of their exposed position,
lacerations involving the ears are rather rare. The auricle contains a cartilaginous