Affiliation:
1. From the University of Washington School of Medicine, Department of Otolaryngology–Head and Neck Surgery, Seattle, WA
2. From the University of Iowa, Department of Otolaryngology–Head and Neck Surgery, The University of Iowa Hospitals and Clinics, Iowa City, IA
3. From the Columbia-Presbyterian Medical Center, Department of Otolaryngology–Head and Neck Surgery, New York, NY
Abstract
OBJECTIVE: Severe ballistic or avulsion injuries to the face create complex, composite defects. We report the results of an aggressive management algorithm to optimize facial form and function: (1) the initial encounter, (2) definitive reconstruction with vascularized tissue, and (3) aesthetic and prosthetic refinement. STUDY DESIGN AND SETTING: Retrospective case series of 49 patients in 2 tertiary care institutions. Patients were evaluated for age, gender, mechanism of injury, anatomic subsites involved, surgical procedures, flaps utilized, complications, and functional outcomes. RESULTS: Forty defects were gunshot wounds, 9 resulted from major avulsive trauma. Involved sites included 13 oromandibular, 21 midface/upper face, and 15 combined sites; 54 free flaps were utilized, 21 were soft tissue and 33 contained bone. No flap failures occurred. Function and cosmesis were best in the oromandibular only group, and worst in the combined group with nasal and/or orbital tissue loss. CONCLUSION: Treatment of severe facial trauma requires early tissue debridement with bony repair and/or stenting to minimize scar contracture. Free tissue transfer techniques allow simultaneous reconstruction of the bony framework and overlying tissues. Multiple secondary procedures are frequently required for optimal aesthetic restoration. EBM rating: C.
Subject
Otorhinolaryngology,Surgery
Cited by
50 articles.
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