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Al Lahham S, Aljassem G, Al-Khayarin A, Sada R, Mogahed H, AlSherawi A. The Use of MartriDerm in Nail Bed Reconstruction of Thumb Injured by a Pellet. PLASTIC AND RECONSTRUCTIVE SURGERY-GLOBAL OPEN 2023; 11:e5197. [PMID: 37753331 PMCID: PMC10519470 DOI: 10.1097/gox.0000000000005197] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Accepted: 06/20/2023] [Indexed: 09/28/2023]
Abstract
Gunshot injuries to the hand and upper extremity can be divided into low and high-energy injuries. Nonballistic firearms such as pellet guns are generally considered low-energy guns but can be associated with serious morbidity and even mortality. Management is tailored according to the severity and type of injured structures. Here, we present the case of a 21-year-old soldier who accidently shot his thumb with an air gun while on a bird hunting trip, whose case was managed with extraction placement of bone graft and collagen matrix to prevent nail deformity. This case was written to increase the awareness about the need for safe use of such guns and to display the authors preferred way of management.
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Affiliation(s)
- Salim Al Lahham
- From Plastic Surgery Department, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
- Fellowship in Hand Reconstruction and Microsurgery, Ganga Hospital, India and DAFPRS fellowship, Netherlands
| | - Ghanem Aljassem
- From Plastic Surgery Department, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Alreem Al-Khayarin
- From Plastic Surgery Department, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | | | - Heba Mogahed
- From Plastic Surgery Department, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
| | - Abeer AlSherawi
- From Plastic Surgery Department, Hamad General Hospital, Hamad Medical Corporation, Doha, Qatar
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Facial Reconstruction Following Self-Inflicted Gunshot Wounds: Predictors, Complications, and Acceptable Outcomes. TRAUMA CARE 2022. [DOI: 10.3390/traumacare2020018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Background: Self-inflicted gunshot wounds (SIGSWs) produce devastating facial defects that are challenging to reconstruct, but are rarely reported in large cohorts in the literature. This study sought to characterize these injuries, and identify parameters influencing complications and outcomes among survivors following facial reconstruction. Methods: A retrospective cohort study was performed identifying 22 patients with SIGSWs to the face reconstructed at our center from 2009 to 2019. Charts were reviewed for patient, injury, and reconstructive details and course. Outcomes were statistically compared to various parameters. Results: The most common firearm, orientation, and injured structure were the handgun (40.9%), submental (59.1%), and mandible (68.2%), respectively. Patients averaged a 21.7-day length of stay (LOS), 17.4 h to debridement, 2.6 days to bony fixation, 5.4 reconstructive surgeries, and 7 (31.8%) patients received at least one free flap. Fifteen (68.2%) patients had at least one major complication, although functional outcomes were ultimately relatively good overall. Notable outcome associations included submental orientation with a longer LOS (p = 0.027), external fixation with a longer LOS (p = 0.014), financial stressors with a shorter LOS (p = 0.031), and severe soft tissue injury with an increased total number of reconstructive surgeries (p = 0.039) and incomplete reconstruction (p = 0.031). There were no cases of suicidal recidivism. Conclusions: Reconstruction following facial SIGSW is challenging for both patient and surgeon, and carries a high rate of complications. However, patients can regain substantial function following reconstruction and the achievement of satisfactory outcomes.
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Vatsyayan A, Adhyapok AK, Debnath SC, Malik K. Reconstruction and rehabilitation of short-range gunshot injury to lower part of face: A systematic approach of three cases. Chin J Traumatol 2016; 19:239-43. [PMID: 27578384 PMCID: PMC4992133 DOI: 10.1016/j.cjtee.2016.01.016] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Gunshot injuries are always known to cause severe morbidity and mortality when head and neck are involved. They vary in morbidity, which can occur in civilian surroundings. The wound largely depends on the type of weapon, mass and velocity of the bullet, and the distance from where it has been shot. Close-range gunshot wounds in the head and neck region can result in devastating aesthetic and functional impairment. The complexity in facial skeletal anatomy cause multiple medical and surgical challenges to an operating surgeon, demanding elaborate soft and hard tissue reconstruction. Here we presented the successful management of three patients shot by short-range pistol with basic life support measures, wound management, reconstruction and rehabilitation.
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Mountziaris PM, Shah SR, Lam J, Bennett GN, Mikos AG. A rapid, flexible method for incorporating controlled antibiotic release into porous polymethylmethacrylate space maintainers for craniofacial reconstruction. Biomater Sci 2016; 4:121-9. [PMID: 26340063 PMCID: PMC4679697 DOI: 10.1039/c5bm00175g] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
Severe injuries in the craniofacial complex, resulting from trauma or pathology, present several challenges to functional and aesthetic reconstruction. The anatomy and position of the craniofacial region make it vulnerable to injury and subsequent local infection due to external bacteria as well as those from neighbouring structures like the sinuses, nasal passages, and mouth. Porous polymethylmethacrylate (PMMA) "space maintainers" have proven useful in staged craniofacial reconstruction by promoting healing of overlying soft tissue prior to reconstruction of craniofacial bones. We describe herein a method by which the porosity of a prefabricated porous PMMA space maintainer, generated by porogen leaching, can be loaded with a thermogelling copolymer-based drug delivery system. Porogen leaching, space maintainer prewetting, and thermogel loading all significantly affected the loading of a model antibiotic, colistin. Weeks-long release of antibiotic at clinically relevant levels was achieved with several formulations. In vitro assays confirmed that the released colistin maintained its antibiotic activity against several bacterial targets. Our results suggest that this method is a valuable tool in the development of novel therapeutic approaches for the treatment of severe complex, infected craniofacial injuries.
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Affiliation(s)
- P M Mountziaris
- Department of Bioengineering, Rice University, Houston, Texas, USA. and Division of Plastic Surgery, Albany Medical Center, Albany, NY, USA
| | - S R Shah
- Department of Bioengineering, Rice University, Houston, Texas, USA.
| | - J Lam
- Department of Bioengineering, Rice University, Houston, Texas, USA.
| | - G N Bennett
- Department of BioSciences, Rice University, Houston, Texas, USA.
| | - A G Mikos
- Department of Bioengineering, Rice University, Houston, Texas, USA.
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Late Oropharyngeal Functional Outcomes of Suicidal Maxillofacial Gunshot Wounds. J Craniofac Surg 2015; 26:691-5. [DOI: 10.1097/scs.0000000000001588] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
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Stefanopoulos P, Soupiou O, Pazarakiotis V, Filippakis K. Wound ballistics of firearm-related injuries—Part 2: Mechanisms of skeletal injury and characteristics of maxillofacial ballistic trauma. Int J Oral Maxillofac Surg 2015; 44:67-78. [DOI: 10.1016/j.ijom.2014.07.012] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2013] [Revised: 04/25/2014] [Accepted: 07/21/2014] [Indexed: 11/26/2022]
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Peled M, Leiser Y, Emodi O, Krausz A. Treatment protocol for high velocity/high energy gunshot injuries to the face. Craniomaxillofac Trauma Reconstr 2013; 5:31-40. [PMID: 23449809 DOI: 10.1055/s-0031-1293518] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2011] [Accepted: 08/16/2011] [Indexed: 10/15/2022] Open
Abstract
Major causes of facial combat injuries include blasts, high-velocity/high-energy missiles, and low-velocity missiles. High-velocity bullets fired from assault rifles encompass special ballistic properties, creating a transient cavitation space with a small entrance wound and a much larger exit wound. There is no dispute regarding the fact that primary emergency treatment of ballistic injuries to the face commences in accordance with the current advanced trauma life support (ATLS) recommendations; the main areas in which disputes do exist concern the question of the timing, sequence, and modes of surgical treatment. The aim of the present study is to present the treatment outcome of high-velocity/high-energy gunshot injuries to the face, using a protocol based on the experience of a single level I trauma center. A group of 23 injured combat soldiers who sustained bullet and shrapnel injuries to the maxillofacial region during a 3-week regional military conflict were evaluated in this study. Nine patients met the inclusion criteria (high-velocity/high-energy injuries) and were included in the study. According to our protocol, upon arrival patients underwent endotracheal intubation and were hemodynamically stabilized in the shock-trauma unit and underwent total-body computed tomography with 3-D reconstruction of the head and neck and computed tomography angiography. All patients underwent maxillofacial surgery upon the day of arrival according to the protocol we present. In view of our treatment outcomes, results, and low complication rates, we conclude that strict adherence to a well-founded and structured treatment protocol based on clinical experience is mandatory in providing efficient, appropriate, and successful treatment to a relatively large group of patients who sustain various degrees of maxillofacial injuries during a short period of time.
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Affiliation(s)
- Micha Peled
- Department of Oral and Maxillofacial Surgery, Rambam Medical Center, Technion-Israel Institute of Technology ; The Ruth and Bruce Rappaport Faculty of Medicine, Technion-Israel Institute of Technology, Haifa, Israel
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Dean NR, McKinney SM, Wax MK, Louis PJ, Rosenthal EL. Free flap reconstruction of self-inflicted submental gunshot wounds. Craniomaxillofac Trauma Reconstr 2012; 4:25-34. [PMID: 22379504 DOI: 10.1055/s-0031-1272899] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
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.
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Abstract
Microvascular free tissue transfer (FTT) is an increasingly used method of reconstruction for traumatic defects of the head and neck. We describe the immediate management, FTT reconstruction techniques, and outcomes of 6 individuals who sustained maxillofacial gunshot trauma and were treated at a single tertiary-care level I trauma center. All 6 patients were white men with a mean age of 33 years. The mandible, nose, and orbital contents were the most frequently affected critical structures. All patients initially underwent primary wound debridement and tracheostomy, with concurrent maxillomandibular wire fixation and/or midface or mandible plate fixation in 5 patients. The mean time from injury to definitive FTT was 38 days. Five patients underwent fibula osteocutaneous FTT and 1 underwent radial forearm fasciocutaneous FTT. One patient also underwent concurrent local tissue rearrangement and pedicled flap surgery for nasal reconstruction. The mean hospital length of stay after FTT was 6 days. All FTT survived without necrosis. Oral incompetence and poor cosmesis from undesirable scarring patterns were the most common long-term complications. In summary, successful reconstruction of head and neck defects caused by gunshot trauma begins with airway stabilization, wound management, and bony fracture reduction and fixation. Definitive microvascular FTT is a useful method of repairing traumatic head and neck defects, although long-term functional and cosmetic complications may still occur.
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Kretlow JD, Shi M, Young S, Spicer PP, Demian N, Jansen JA, Wong ME, Kasper FK, Mikos AG. Evaluation of soft tissue coverage over porous polymethylmethacrylate space maintainers within nonhealing alveolar bone defects. Tissue Eng Part C Methods 2010; 16:1427-38. [PMID: 20524844 PMCID: PMC3003916 DOI: 10.1089/ten.tec.2010.0046] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2010] [Accepted: 04/09/2010] [Indexed: 12/27/2022] Open
Abstract
Current treatment of traumatic craniofacial injuries often involves early free tissue transfer, even if the recipient site is contaminated or lacks soft tissue coverage. There are no current tissue engineering strategies to definitively regenerate tissues in such an environment at an early time point. For a tissue engineering approach to be employed in the treatment of such injuries, a two-stage approach could potentially be used. The present study describes methods for fabrication, characterization, and processing of porous polymethylmethacrylate (PMMA) space maintainers for temporary retention of space in bony craniofacial defects. Carboxymethylcellulose hydrogels were used as a porogen. Implants with controlled porosity and pore interconnectivity were fabricated by varying the ratio of hydrogel:polymer and the amount of carboxymethylcellulose within the hydrogel. The in vivo tissue response to the implants was observed by implanting solid, low-porosity, and high-porosity implants (n = 6) within a nonhealing rabbit mandibular defect that included an oral mucosal defect to allow open communication between the oral cavity and the mandibular defect. Oral mucosal wound healing was observed after 12 weeks and was complete in 3/6 defects filled with solid PMMA implants and 5/6 defects filled with either a low- or high-porosity PMMA implant. The tissue response around and within the pores of the two formulations of porous implants tested in vivo was characterized, with the low-porosity implants surrounded by a minimal but well-formed fibrous capsule in contrast to the high-porosity implants, which were surrounded and invaded by almost exclusively inflammatory tissue. On the basis of these results, PMMA implants with limited porosity hold promise for temporary implantation and space maintenance within clean/contaminated bone defects.
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Affiliation(s)
| | - Meng Shi
- Department of Bioengineering, Rice University, Houston, Texas
| | - Simon Young
- Department of Bioengineering, Rice University, Houston, Texas
- Department of Oral and Maxillofacial Surgery, The University of Texas Health Science Center at Houston, Houston, Texas
| | | | - Nagi Demian
- Department of Oral and Maxillofacial Surgery, The University of Texas Health Science Center at Houston, Houston, Texas
| | - John A. Jansen
- Department of Periodontology and Biomaterials, Radboud University Nijmegen Medical Center, Nijmegen, The Netherlands
| | - Mark E. Wong
- Department of Oral and Maxillofacial Surgery, The University of Texas Health Science Center at Houston, Houston, Texas
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Shi M, Kretlow JD, Nguyen A, Young S, Baggett LS, Wong ME, Kasper FK, Mikos AG. Antibiotic-releasing porous polymethylmethacrylate constructs for osseous space maintenance and infection control. Biomaterials 2010; 31:4146-56. [PMID: 20153893 PMCID: PMC2839066 DOI: 10.1016/j.biomaterials.2010.01.112] [Citation(s) in RCA: 83] [Impact Index Per Article: 5.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2009] [Accepted: 01/19/2010] [Indexed: 02/06/2023]
Abstract
The use of a strategy involving space maintenance as the initial step of a two-stage regenerative medicine approach toward reconstructing significant bony or composite tissue defects in the craniofacial area, preserves the void volume of bony defects and could promote soft tissue healing prior to the subsequent definitive repair. One of the complications with a biomaterial-based space maintenance approach is local infection, which requires early, effective eradication, ideally through local antibiotic delivery. The purpose of this study is to develop a dual function implant material for maintaining osseous space and releasing an antibiotic to eliminate local infection in bony defects. Colistin, a polymyxin antibiotic, was chosen specifically to address infections with Acinetobacter species, the most common pathogen associated with combat-related traumatic craniofacial injuries. Porous polymethylmethacrylate (PMMA) constructs incorporating poly(lactic-co-glycolic acid) (PLGA) microspheres were fabricated by mixing a clinically used bone cement formulation of PMMA powder and methylmethacrylate liquid with a carboxymethylcellulose (CMC) hydrogel (40 or 50 wt%) to impart porosity and PLGA microspheres (10 or 15 wt%) loaded with colistin to control drug release. The PMMA/CMC/PLGA construct featured mild setting temperature, controllable surface/bulk porosity by incorporation of the CMC hydrogel, reasonably strong compressive properties, and continuous drug release over a period of 5 weeks with total drug release of 68.1-88.3%, depending on the weight percentage of CMC and PLGA incorporation. The concentration of released colistin was well above its reported minimum inhibitory concentration against susceptible species for 5 weeks. This study provides information on the composition parameters that enable viable porosity characteristics/drug release kinetics of the PMMA/CMC/PLGA construct for the initial space maintenance as part of a two-stage regenerative medicine approach.
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Affiliation(s)
- Meng Shi
- Department of Bioengineering, Rice University, Houston, TX USA
| | | | - Anson Nguyen
- School of Medicine, University of Texas Medical Branch at Galveston, Galveston, TX USA
| | - Simon Young
- Department of Bioengineering, Rice University, Houston, TX USA
- Department of Oral and Maxillofacial Surgery, University of Texas Health Science Center at Houston, Houston, TX USA
| | | | - Mark E. Wong
- Department of Oral and Maxillofacial Surgery, University of Texas Health Science Center at Houston, Houston, TX USA
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Can M, Yildirim N, Ataç GK. Dissecting firearm injury to the head and neck with non-linear bullet trajectory: A case report. Forensic Sci Int 2010; 197:e13-7. [DOI: 10.1016/j.forsciint.2009.12.050] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2008] [Revised: 11/17/2009] [Accepted: 12/16/2009] [Indexed: 10/19/2022]
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Nawal RR, Sehgal R, Ansari I, Talwar S, Sood A, Verma M. Endodontic management of horizontally placed molars after gunshot injury to mandible: a case report. ACTA ACUST UNITED AC 2009; 108:e82-8. [PMID: 19734072 DOI: 10.1016/j.tripleo.2009.06.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2009] [Revised: 06/22/2009] [Accepted: 06/25/2009] [Indexed: 11/26/2022]
Abstract
A 37-year-old man reported to our department with the history of gunshot injury to the mandible 15 years before. His anterior mandible had been resected earlier and bone graft was seen. Intraoral examination of lower jaw revealed 4 remaining mandibular molars. These teeth were severely rotated such that they lay horizontal with respect to the mandibular base. Preoperative Dentascan spiral computerized tomography (CT) of the patient revealed obliteration of the mesial canals of the mandibular right first molar and pear-shaped internal resorption defect in the distal canal of the same tooth. This paper reports the challenging endodontic management of a rare case of severely angulated teeth also exhibiting traumatic sequelae in both roots of the impact tooth. It also highlights the usefulness of spiral CT scan in diagnosis of traumatic sequelae such as pulp canal obliteration and internal resorption.
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Affiliation(s)
- Ruchika Roongta Nawal
- Department of Conservative Dentistry and Endodontics, Maulana Azad Institute of Dental Sciences, New Delhi, India.
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Microsurgical Reconstruction of Posttraumatic High-Energy Maxillary Defects: Establishing the Effectiveness of Early Reconstruction. Plast Reconstr Surg 2007; 120:103S-117S. [DOI: 10.1097/01.prs.0000260728.60178.de] [Citation(s) in RCA: 51] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Rustemeyer J, Kranz V, Bremerich A. Injuries in combat from 1982–2005 with particular reference to those to the head and neck: A review. Br J Oral Maxillofac Surg 2007; 45:556-60. [PMID: 17316932 DOI: 10.1016/j.bjoms.2007.01.003] [Citation(s) in RCA: 48] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/13/2007] [Indexed: 11/27/2022]
Abstract
The aim of this review was to examine the range of combat injuries with particular reference to those of the head and neck. We evaluated 10 retrospective studies selected from the period 1982-2005 that covered war injuries from Vietnam, Lebanon, Slovenia, Croatia, Iraq, Somalia, and Afghanistan. We found differences in the causes of injuries. Injuries from fragments were more common during the 90s than during the Vietnam War, where shooting injuries predominated. Injuries to the trunk were reduced in conflicts from 1991 onwards as military personal armour systems including protective vests were used. However, the mortality of wounded soldiers in all conflicts was consistently between 10% and 14%. There was a high incidence of injuries to the head and neck (up to 40%) though they affected only 12% of the body surface area. Though the data from the different military conflicts are not totally comparable, there are trends in the type of injuries and mortality, which may lead to changes in existing systems of medical care.
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Affiliation(s)
- Jan Rustemeyer
- Department of Cranio-Maxillofacial Surgery, Klinikum Bremen Mitte, Bremen, Germany.
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Abstract
PURPOSE OF REVIEW Gunshot wounds to the head and neck result in significant bone and soft tissue loss. These defects pose a challenge to the facial reconstructive surgeon. This paper reviews the current literature on the management of ballistic injuries to the head and neck and outlines a treatment algorithm. RECENT FINDINGS With recent advances in free tissue transfer, early definitive reconstruction of bone and soft tissue deficits with vascularized flaps has become the treatment of choice. Computed tomography angiography of the neck has been shown to be a sensitive, specific, and safe technique in screening for vascular injuries. SUMMARY Management of ballistic injuries to the head and neck begins with advanced trauma life support protocols. Computed tomography angiography is now widely available and provides an accurate and rapid evaluation of head and neck vasculature. The initial operation aims to establish occlusion, stabilize bone and close soft tissue defects. Serial debridement of wounds with delayed reconstruction has given way to early definitive repair with vascularized tissue. This has led to improved function, fewer operations, and shorter hospital stays.
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Affiliation(s)
- Vishal S Doctor
- Department of Otolaryngology-Head and Neck Surgery, UC Davis Medical Center, Sacramento, California, USA
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Vayvada H, Menderes A, Yilmaz M, Mola F, Kzlkaya A, Atabey A. Management of Close-Range, High-Energy Shotgun and Rifle Wounds to the Face. J Craniofac Surg 2005; 16:794-804. [PMID: 16192858 DOI: 10.1097/01.scs.0000180014.06352.65] [Citation(s) in RCA: 45] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Close-range, high-energy shotgun wounds of the face are life-threatening and devastating traumas of the face. Suicidal attempts are the main reason in the great majority of the patients in civilian life. There is no consensus on the timing of reconstruction for bone and soft tissue defects resulting from high-energy shotgun wounds. The conventional method is primary repair as soon as possible and serial debridements and definitive reconstruction in the delayed stage. An alternative to this approach is the immediate definitive surgical reconstruction of the patient during the first operation for acute management of trauma. We had 15 patients with close-range, high-energy shotgun wounds in 10 years. Six of 15 patients referred to our center for definitive reconstruction after the acute management of the patients were performed in another center and the rest were all admitted in the acute period. Either conventional approach with delayed reconstruction for 10 patients or immediate definitive surgical reconstruction for 5 patients was used. Immediate reconstruction eliminated disadvantages of the conventional method such as high infection and scarring rate and deformities resulting from contraction of tissues. The emotional conditions of the patients were evaluated and major depression signs were determined. Functional evaluation showed that there was great correlation between facial appearance after reconstruction and social activity level.
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Affiliation(s)
- Haluk Vayvada
- Department of Plastic and Reconstructive Surgery, Dokuz Eylul University, Faculty of Medicine, Izmir, Turkey.
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Futran ND, Farwell DG, Smith RB, Johnson PE, Funk GF. Definitive management of severe facial trauma utilizing free tissue transfer. Otolaryngol Head Neck Surg 2005; 132:75-85. [PMID: 15632913 DOI: 10.1016/j.otohns.2004.08.013] [Citation(s) in RCA: 35] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
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.
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Affiliation(s)
- Neal D Futran
- University of Washington School of Medicine, Department of Otolaryngology-Head and Neck Surgery, Seattle 98195-6515, USA.
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Herford AS. Early repair of avulsive facial wounds secondary to trauma using interpolation flaps. J Oral Maxillofac Surg 2004; 62:959-65. [PMID: 15278860 DOI: 10.1016/j.joms.2004.01.020] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
PURPOSE This article describes the use of various local interpolation flaps for the reconstruction of facial defects resulting from trauma. PATIENTS AND METHODS Fifteen interpolation flaps were used to restore missing tissue of 14 patients who sustained trauma. Two of the procedures were performed as a single stage, whereas 13 flaps required a separate surgery to "take down" the pedicle. All flap procedures were performed within 72 hours from the time of trauma. Four types of interpolation flaps were used. RESULTS All flaps healed without evidence of infection, dehiscence, or necrosis. Two patients required secondary treatment 6 months after the flap procedure. CONCLUSION Various local interpolation flaps provide a reliable and aesthetic treatment option for early repair of soft tissue defects secondary to trauma.
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Affiliation(s)
- Alan S Herford
- Department of Oral and Maxillofacial Surgery, Loma Linda University Medical Center, Loma Linda, CA 92350, USA.
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