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James Barrett Brown, M.D.; Minot P. Fryer, M.D.
JAMA. 1954;155(9):828-829. doi:10.1001/jama.1954.03690270024008.
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Internal wire pin fixation of a severe facial fracture at the time of the primary repair is an important procedure in efforts to avoid the use of complicated external appliances and to at least keep to a minimum the necessity for secondary reconstructive procedures. As a fundamental rule facial wounds should be closed as soon as possible to avoid infection and fibrosis and permanent fixation out of position of small bone fragments and to align soft tissue features before distortion and shrinkage.

Soft tissue lacerations and tears are accurately closed with deep fixation sutures and with small sutures placed close to the edge of the wound after adequate cleansing and débridement. Any possibly viable tissue is never cut away. Known points are approximated, and, when none are apparent, the wound is closed at the center, and repeated bisection of the open area is done with sutures; the wound is not


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