Free Flap Reconstruction of Self-Inflicted Submental Gunshot Wounds

Abstract

In this study, we review outcomes for 15 patients with self-inflicted submental gunshot wounds requiring free flap reconstruction. Patients presented to two tertiary care centers over a 7-year period. Mean age was 46 years (range, 16 to 76 years), 67% ( n = 10) had a psychiatric history, and four were known to abuse illicit substances. Patients with oromandibular involvement required on average a total of 2.8 procedures, and those with midface (3.7) or combined defects (6) required more total procedures ( p = 0.21). Donor sites included osteocutaneous radial forearm ( n = 8), fibula ( n = 4), fasciocutaneous radial forearm ( n = 5), and anterior lateral thigh ( n = 1). Median length of hospitalization was 8 days. Overall complication rate was 33% ( n = 5), and included hematoma ( n = 1), fistula ( n = 1), and mandibular malunion ( n = 2). Most patients were able to tolerate a regular or soft diet (92%), maintain oral competency (58%), and demonstrate intelligible speech (92%) at a median time to follow-up of 12 months. Despite the devastating nature of this injury, free flap reconstruction of self-inflicted submental gunshot wounds results in acceptable functional results for the majority of patients.