Cat scratch fever in the FACE
April 29, 2012 3:41 PM   Subscribe

What can I expect while healing a facial laceration that required stitches?

Last night I had my feet up with an ice pack on my ankle and my cat was studiously sniffing it. I went to move him so I could get up and go to bed and he jumped straight up in the air using my wrists and palms as claw launchpads, and then launched himself forward, kicking me in the face with his back foot and snagging my lip from a little above the rim of my top lip to about halfway into the pink part. After stopping the bleeding, my husband convinced me that the lip laceration was deep enough to go to the ER, so we went (hooray for living two blocks from a hospital). The lip laceration was deep enough to require seven stitches. Fortunately, there was a plastic surgeon on duty to put them in. I am scheduled to see him for suture removal in 9 days.

My question is mostly for people who have experienced stitches in their face or lip: how long should I expect the swelling to last? The nurse advised me to use gel packs to control swelling, so I am doing that, but I would like to know when I will resemble a human more than a duck. Also, I'm supposed to travel on business on Wednesday morning and I'd like to know if I can expect the swelling and appearance of the wound to be less terrifying to the general public by then. In addition, is there anything I can do to minimize the potential for scarring besides using bacitracin ointment while the stitches are in and Vitamin E after they're out? Also, how the hell do I eat?

Potentially relevant details: cat is current on all his shots, tested negative for all feline diseases including Bartonella, and is indoor-only. The hospital gave me Levaquin (an antibiotic) to take to prevent infection. The wounds were all washed thoroughly with Hibiclens prior to going to the hospital and were cleaned with iodine at the hospital. I am otherwise healthy.
posted by bedhead to Health & Fitness (15 answers total)
Ibuprofen will reduce swelling and inflammation.
posted by lulu68 at 3:46 PM on April 29, 2012

Monitor that wound very, very carefully. I have two friends who take good care of their cats and who have both had bad infections from cat scratches. If anything look/feels weird, please go immediately to the doc/hospital.
posted by pised at 3:51 PM on April 29, 2012 [1 favorite]

besides infection and de-inflammation, try to put some clean silk between your wound and your pillow once it's clear of the dressing, or any other surface you lean it against.

Also do not waste money with Bio Oil, buy cheap drugstore Vit E oil capsules, stick a pin in them and apply directly to the wound once the dressing is off. (I drink with a bunch of Plastic surgeons, you tend to pick things up as you go along, they don't rate me as I deal in guts and poop)
posted by Wilder at 4:04 PM on April 29, 2012 [1 favorite]

Poultices of arnica and comfrey will help heal you up faster. I'm not an herbalist so you might want to do your own research to confirm that this would be right for you, but I've seen them work wonders. You should be able to find them in the bulk herbs section at your local natural foods store.
posted by aniola at 4:06 PM on April 29, 2012

I've had a cat scratch on my face. It was pretty bad, bled a lot, was very ugly and painful. I ended up not needing stitches, they glued my face back together. The swelling was much better after the second day, but at that point, a lovely bruise appeared. The bruise was better than the swelling, but was still not pretty. I used gel packs and ibuprofen. I always considered myself lucky because the scratch was less than an inch below my eye. I have a very faint scar that you can only see if I point it out.
posted by upatree at 4:17 PM on April 29, 2012

Best answer: Cat scratch fever is a real thing, not just an old rock song, so monitor how you feel overall and report any weirdness to your doctor. I'm not your plastic surgeon, but in my practice, facial stitches come out in 3-5 days. The longer they stay in the more likely the suture track can epithelialize, leading to that undesirable "train track" deformity. Faces, lips in particular, are vascular as hell so those wounds bleed like crazy and swell afterwards to match. Gel packs (or frozen peas) can help decrease it. There's lots of anecdata about arnica and some cosmetic surgeons swear by it. I don't do cosmetic surgery anymore and have no personal experience using it.

Laughing, smiling and drinking anything acidic or alcoholic is painful/uncomfortable for a few days but it passes surprisingly quickly. Levaquin is acceptable, albeit expensive, so finish that course of antibioitics until they are gone. You'll want to protect your immature scar for about 6 months from UV exposure (sun) or you can end up with a permanent color mismatch. Two weeks after the wound, you will look at the scar and think "not too bad". Two months after you will wonder what quack they found on the street to close your lip. It won't look it's best until at least 6 months have passed.

TL, DR- in one doctor's opinion (me), 9 days is way too long to leave those sutures in. Look into having them removed sooner.
posted by karlos at 4:40 PM on April 29, 2012 [3 favorites]

Response by poster: Thanks for all the answers so far. I know cat scratch fever is a real thing, which is caused by Bartonella, and I know the cat is negative for that. Levaquin is a treatment for it, so I think my bases are covered on that front.

I will get a second opinion on the timing of the stitch removal, karlos. Thank you.
posted by bedhead at 5:03 PM on April 29, 2012

Seconding Wilder. Once the stitches are out, rub vitamin e into the scar.
posted by swngnmonk at 5:20 PM on April 29, 2012

I was kicked in the chin and flew abroad seven or so hours later. The stitches stayed in for probably eight or nine days as I couldn't get them taken out while away, but the scar is on the underside and the ER did a fantastic job so it's only possible to feel it. My athletic trainer took them out and my understanding is that it is generally uncomplicated-- maybe it would be possible to have it evaluated earlier during that time period to make sure it's healing okay and whether the surgeon needs to see to it his/herself at the later date? The swelling does go down fairly quickly with timely doses of ibuprofen and ice. I found that cradling ice-cold soda cans worked well as an innocuous and easy-to-come-by gel pack alternative. If eating and drinking are hard, maybe Vaseline or a heavy duty unscented/colored balm would help soothe the skin around the cut and provide a protective layer? I imagine soups and smoothies and other spoon/straw foods might be easier to handle outside of business contexts.
posted by jetlagaddict at 6:55 PM on April 29, 2012

If you are not a a strict and still back sleeper, sleep in a chair for the first few days, so you don't mess up the stitches by rubbing against a pillow.

How are you handling the pain? Will that be a factor for your travel on Wednesday? You may consider rescheduling if you will not be at your best.

I did have my lip stitched a few years ago, but my injury was not as bad as yours. I slept poorly in a chair, and ate soft unbaked squished up dinner rolls and milkshakes for a few days after a day of not eating. I'd describe my pain as terrible, but different people have different thresholds. My scar is small, and I kinda dig it.

Good luck to you - the best thing you've already done, which was go to the hospital and get the stitching.
posted by rainbaby at 4:40 AM on April 30, 2012

Yeah, seconding the removal of the sutures. ToddlerTaff just had a plastic surgeon suture together her brow.... not from cage-fighting, although that's what we told them at pre-school.... and the surgeon and his registrar and the post-op plastic clinic all told us that sutures need to come out by day five OR THERE WILL BE HORRIBLE SCARRING! T

oddlerTaff had dissolving sutures because she's a serious cage-fighter. But if you're an adult that can sit still, you'd have normal ones and they should be out by day five.

Oh, and get the silicone gel to help it heal afterwards. It's about $50AUD per tube, but the research says it helps.

ToddlerTaff's cage-fight was four weeks ago, at Petersham Bowling Club, Sydney, Australia... i.e. best medical treatment in the world. Or at least, not too shabby.
posted by taff at 4:53 AM on April 30, 2012

There are a few recommendations here for Vitamin E, but it may be helpful to know that Vitamin E has not been proven effective in improving scars and, in some cases, may cause dermatitis and worsen scar appearance. There is an article here. There are abstracts here, here, and here.
posted by nobodyyouknow at 7:18 AM on April 30, 2012

Yes, chiming in to second nobodyyouknow--I had facial surgery a few years ago, and my fairly-up-to-date plastic surgeon told me that the latest evidence shows that Vitamin E actually worsens scarring. I'd stay away from that for sure.

I was RELIGIOUS about keeping my face scar out of the sun (I actually used a band-aid whenever outdoors for the first month, then graduated to a sunblock that used zinc oxide + hat for the next year), and also used the silicone scar sheets every night, which my plastic surgeon said were one of the only treatments shown to actually improve the appearance of scarring. It worked so well that my new dermatologist wasn't able to pick out where the scar was a few weeks ago without me pointing it out to her.
posted by iminurmefi at 8:57 AM on April 30, 2012

If you can deal with the appearance, the silicon scar sheets work WONDERS. Try to get those if you can.
posted by JoeZydeco at 11:18 AM on April 30, 2012

Just came in to nth the silicone sheets. My doctor recommended these New Gel strips after I had surgery last year on my neck/face, and they seemed to really help with the healing process. When I first came home from the hospital with the stitches I looked like a very frightening horror move monster, but now 6 months later the scar is barely even noticeable (yay!). They also have a gel version for difficult spots where the sheets might not work.
posted by bobafet at 11:46 AM on April 30, 2012

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