The face is a special part of the body that reflects the appearance and temperament of the human body, and even a very minor abnormality in appearance can undermine the patient’s self-confidence and affect the quality of life in the future. In order to minimize the occurrence of deformities, it is important to consult an orthopedic surgeon or use the principles of orthopedics to treat emergency head and facial trauma. Usually in the emergency room, there are many people and limited conditions, as long as there is no big deal, the emergency surgeon in the clean-up suture usually use thick needle and large thread to sew two or three stitches on the whole layer, and then forcefully tie the knot to tighten the wound on both sides, so as to stop the bleeding and close the wound, quickly and effectively. However, it is the thick stitches and tight knots that cause the unsightly “centipede” shaped scar after surgery. Sometimes, due to incomplete emergency debridement or improper tissue repositioning, foreign body residue and local dysfunction may also occur, requiring second-stage repair. Unlike emergency surgery, plastic surgeons are much more meticulous when dealing with emergency trauma, especially when it comes to facial trauma. Post-operative function and appearance are always the first priority. Depending on the condition of the wound and whether there is also combined damage to important tissues such as nerves, muscles, ducts, and bones, we will develop different surgical plans to minimize the patient’s pain. When cleaning the wound, we try to make it as thorough as possible to avoid foreign bodies or contaminants from affecting the post-operative healing, and when suturing, we try to restore each layer of the injured tissue to its original position as much as possible, layer by layer, especially in the iconic positions such as eyebrows, lips, human middle, and corners of the eyes, and strive to align them neatly. In order to completely eliminate the tension of the skin suture and minimize the possibility of scar growth, we have to do one more step of dermal suture before sewing the skin. After the dermis is sutured, the wound is already very flat and there are basically no gaps. Finally, the skin only needs to be sutured with a fine thread to make the two sides of the wound more perfectly aligned. The difference between such a wound and an acute surgical wound is naturally self-explanatory. After the wound is cleared and sutured, antibiotics are usually used routinely for about 3 days, with a change of medication on the second or third day to clean the blood scabs and exudates. When the injury is allowed and there is no life threatening situation, all soft tissue injuries on the surface of the body can be repaired by plastic surgery, especially traumatic injuries involving the head and face, for different cases, we will have different treatments. If the injury is extensive and involves other tissues and organs, we can also cooperate with other departments to complete the work of debridement and suturing. Wounds that are unsatisfactory after emergency debridement and suturing can also be re-sutured within 48 hours depending on the situation. Supplementary: About sutures: Often patients with traumatic injuries ask us to use sutures that do not need to be removed, thinking that the scar of the wound will be smaller if no sutures are removed. This is actually a misconception. The tissue reaction of the absorbable thread during the absorption process will increase the scar reaction of the wound to some extent. The most suitable sutures for skin closure are monofilament non-absorbable sutures with little tissue reaction, such as nylon or prolene threads. Intradermal sutures or interrupted sutures can be used. Intradermal sutures do not leave stitches, but they are more demanding on the skin on both sides of the wound, and many trauma patients have more severe contusions of the skin at the wound edges. The stitches in our department are very fine and do not strangle very tightly when sewing the skin, so you do not have to worry about leaving stitches after surgery. The subcutaneous layer can be closed with either absorbable or non-absorbable thread, both of which have their advantages and disadvantages. However, some people are sensitive to the absorption of sutures, and the local redness of the wound will be longer after using absorbable thread, which may aggravate the scar reaction to a certain extent. The disadvantage of non-absorbable threads is that they are stronger and have a longer tensile strength, but the subcutaneous sutures may be exposed from the wound, and the exposed sutures are an irritant to the scar and need to be removed in time.