MANAGEMENT OF ACQUIRED SOFT TISSUE DEFECTS OF FACE

Abstract

Background: Since time immemorial, soft-tissue defects of face due to injuries have been documented in literature and even depicted in sculptures, reflecting the image of society. Facial injuries themselves are rarely life-threatening, but are indicators of the energy of injury. Soft-tissue defects of the face can arise out of various causes which may include simple or complex contused lacerations with loss of tissue, avulsions, bites and burns. Common etiologies are road traffic accidents, foreign bodies, defects secondary to tumor excision, homicidal trauma, thermal, chemical and electrical burn, suicidal injuries, human bites, animal bites, gunshot injuries and blast injuries. The management of acquired soft tissue defects of face requires precise planning and coverage by a modality which is functionally and aesthetically pleasant. Objectives: To study the epidemiology of acquired soft tissue defects of face. To restore the aesthetics of the face by resorting to appropriate modality of reconstruction. Materials & Methods: This study was conducted in the Department of Surgery, Govt. Medical College Jammu, J&K, India and included 40 patients having been diagnosed with acquired soft-tissue defects of the face admitted in surgery ward from November 2018 to October 2019 (Prospective study). All the defects were evaluated for size, depth, and status of the base of the defect (presence of gross contamination or infection, integrity, and viability of the wound edges) along with evaluation and documentation of cranial nerve function, particularly the facial and trigeminal nerves. The management depended upon the defect site, size, status and type. 52.5 % patients underwent flap coverage whereas 22.5% underwent skin grafting for coverage of defects. 25% of the patients underwent primary closure of the facial defects. Results: Majority of the patients had restoration of anatomy and normal function after reconstructive procedures with colour and contour matching of that of the recipient site. No major complication was encountered in any of the patients. Conclusion: Acquired soft tissue defects of the face can be reconstructed by a variety of modalities which should not only be functionally adequate but also aesthetically appealing. Flaps are a versatile modality of reconstruction with the choice of flap being governed by the site and size of the defect.