shoulda coulda woulda

We had our first face laceration this past weekend. And it was a doozy – not the ‘ole dermabond fixer-upper! My 3-year-old twin, Owen, was kicked off the bed by his big sis (name undisclosed because she is still traumatized:-). He fell just right so that he bit all the way through his bottom lip, inside and out. The crazy part was that Randy and I had just returned from a weekend away sans kids. This happened maybe 57 minutes after we walked in the door. Yet another sign that we should just stay home with our kids until they leave for college!

Off to the ER I went at 8pm on a Sunday night. I knew I was in for a long night. Thankfully, I remembered our recent Five Tips (and one funny story) from the ER blog and knew exactly what I needed to take with me. I opted not to bring my laptop since I knew I would be all-consumed with sweet Owen and his gaping wound. When we got situated in our room, I asked the nurse immediately if we should consult with a pediatric plastic surgeon. I was told to wait until the ER doctors evaluated him and we’d make a plan from there. So four hours later (not kidding, 1:00am!) we saw the ER doctors and they assured me that yes, Owen’s mouth was pretty mangled, but this was something they could definitely handle. So I agreed, against my mother’s intuition telling me that I really should demand a plastic surgeon.

Owen was a trooper during the procedure. We opted for laughing gas which was less intrusive and less risk than anesthesia. Although this was a risk in itself with Owen’s young age since it required his full cooperation to breathe through his nose. Most 3-year-olds wig out by this point and once they scream and cry, it’s all over since all breathing is through the mouth, thus the laughing gas doesn’t work. Owen actually successfully breathed in the laughing gas and his movements were minimal while the doctors worked on him. After they finished, they complimented mom on her calm demeanor and said that Owen’s cooperation had a lot to do with me. I really think it was how I prepared him (since I had quite some time to go over things with him!). I must have told him 100 times, “Owen, this is soooo important for you to understand. You HAVE to breathe through your nose so you can smell the strawberries (his mask was scented) and your owie won’t hurt. But if you don’t, your owie will hurt more than it does right now.” I really think he got it. Once he was a little loopy, he told the doctors that “this takes too long!” I thought that was pretty funny since he was saying this at 1:30am! In the end, Owen got 4 stitches on the outside and maybe 8-10 on the inside. My hubby is still mad at me that I didn’t get an exact stitch count!

So what did I learn? Well, I’m really kicking myself that I didn’t go with my gut and demand a plastic surgeon consult. This is my son’s mouth and future smile that was at stake. And although I’m sure we received adequate care, it may not have been the best stitching since it wasn’t done by an expert in that field. I now know that you absolutely have the right to demand a plastic surgeon in the emergency room. It will take you twice as long but I think it’s worth the wait. You only get one shot at doing it right. Once the stitches are in, you have to wait until the healing process completes, which is usually 3 months. And then you can start your process with a plastic surgeon which I’m pretty sure will result in an insurance nightmare among other things. I also learned a good Smarty tip. If you’re rushing off to the ER with a face injury, you should just go ahead and call a pediatric plastic surgeon in route. I’m listing the two groups that my pediatrician recommends below. I sure wish I had this information before Sunday.

–David Matthews Craniofacial and Reconstructive Surgery
–Carolinas Cosmetic and Plastic Surgery, Dr. Lefaivre

Also note that most hospitals have a pediatric plastic surgeon on call at all times. Again, just be prepared that you will wait a long, long time while waiting for that consult. But you won’t regret it and you’ll leave knowing you did the best you could.

Do you have experience with emergency pediatric plastic surgery? Do tell!

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