Clinical Characteristics and Management of Pediatric Facial Wounds with Documented Infection or Delayed Presentation: A 25-Year Retrospective Case Series

Background/Objectives: Evidence on infected and delayed pediatric facial wounds outside the setting of animal bites is limited. This study characterized the anatomy, wound characteristics, management, and documented outcomes of pediatric facial wounds with documented infection or delayed/non-recent presentation. Methods: We retrospectively reviewed patients younger than 18 years, identified by electronic free-text search, who presented at a single tertiary trauma center from 2000 to 2024. The hospital recorded 24,877 pediatric facial-wound presentations during the same period. Records were classified as clinically infected when the source dataset coded infection as present and as delayed/non-recent when infection was coded absent but the record described delayed or non-recent presentation. Descriptive analyses and exploratory two-sided Fisher exact tests used variable-specific denominators. Results: Of 92 screened records, 89 met the inclusion criteria: 61 were record-coded as clinically infected and 28 as delayed/non-recent. The selected cohort represented 0.36% of all pediatric facial-wound presentations. Perioral wounds accounted for 46/89 cases and forehead/periorbital wounds for 34/89. Wounds were superficial in 36/89 (40%), subcutaneous in 35/89 (39%), intramuscular in 15/89 (17%), and of unknown depth in 3/89 (3%). Initial closure was documented in 22/89 (25%). All eight dog-bite wounds occurred in the infected group, and none had been initially closed. Post-presentation antibiotics were documented in 48/58 (83%) evaluable infected and 5/28 (18%) delayed/non-recent records; admission was documented in 26/59 (44%) and 2/28 (7%), respectively. Conclusions: This case series describes a small, selected subset of pediatric facial-wound presentations. Mechanism, depth, anatomy, and management differed between the two record-defined groups, but the retrospective sampling and classification framework precludes causal or incidence inference.