Microsurgical reconstruction of complex maxillofacial gunshot wounds: Outcomes analysis and algorithm

Abstract

Background Satisfaction with appearance, functional outcomes (speech, swallowing), work status after microsurgical reconstruction for maxillofacial gunshot wounds (GSW) remain largely unknown. The purpose of this study is to report these parameters. By investigating these outcomes, we also aimed to provide microsurgical algorithms for complex maxillofacial GSW. Methods Forty‐two consecutive maxillofacial GSW patients between 2006 and 2014 were analyzed for outcomes. Mean age was 41.3 years ranging 14 to 77 years. There were 33 males and 9 females. Results Twenty‐four patients received 36 free flaps for early reconstruction in 1 to 2 weeks, two patients in a delayed manner. Fifteen fibula flaps for mandible reconstruction, five fibula, there radial forearm (RF), and two scapular osteocutaneous (OC) flaps for maxilla reconstruction, two RF flaps for palate reconstruction, one RF for cheek reconstruction were used. Four patients underwent innervated gracilis flap for total lower lip and one for cheek reconstruction. Rectus abdominis myocutaneous flap was used for mid‐face defects in two patients. One anterolateral thigh flap was used for lower lip/chin reconstruction. Nine free flaps were performed to treat a complication and/or to improve function. All flaps survived except for three partial skin paddle loss to fibula flaps. Mean follow‐up was 17.2 months. Return to work/school was 70%. Surveys noted 58% “satisfied”. All patients but two achieved perceptible speech, the majority had no difficulty with swallowing, all patients had oral competence. Conclusions Favorable outcomes were obtained in most maxillofacial GSW. After investigating these outcomes, microsurgical algorithms were developed for clinical practice for reconstruction of composite mandible and total‐lower lip defects, and maxilla/mid‐face defects.

Reconstruction after complete mandibular avulsion with double‐paddle fibular free flap. A case report

“…Gracilis muscle flap has been reported for functional reconstruction of the lower lip (Gurunluoglu et al, 2012). However, a recent study showed that performing two free flaps did increase the risk of complications which, probably, could be attributed to complexity of injuries and reconstruction, as well as surgeon fatigue and technical factors (Gurunluoglu & Gatherwright, 2019). Especially in a delicate and unstable patient like this, we decided it was better not to further lengthen the operating time already long in itself, and consequently to harvest a single flap.…”

Manejo dos pacientes com ferimentos em face ocasionados por projéteis de arma de fogo (PAF): Revisão de literatura

“…Do ponto de vista da Física, os danos causados pelos projéteis podem ser explicados pela energia cinética carregada pela bala, que é transferida para o corpo do indivíduo. Esse poder de destruição está ligado diretamente com a velocidade que o objeto alcança; assim, a energia transferida determina o dano efetivo no indivíduo baleado (Gurunluoglu & Gatherwright, 2019). Além da bala, o tipo de arma é outro instrumento que está diretamente ligado às lesões, podendo ser classificadas pelo comprimento do cano, tipo de munição e o propelente (carga de projeção) (Prat et al, 2017).…”

Speech Characteristics and Oromyofunctional Outcomes in Two Bimaxillary Face Transplantation Patients in Helsinki

“…The original trauma and subsequent complications and surgeries often render the tissues scarred thus making future corrections even more difficult. 3 FT requires a complex multidisciplinary team approach rendering the patients dependent on immunosuppressive medication and potentially predisposes them to severe infections and rejection episodes. 4 While to date, 45 FTs have been performed, the number of reports on the different functional results after FT are still scarce.…”

“…Commonly, these problems are related to both the soft tissues and bony structures of the lower and midface. The original trauma and subsequent complications and surgeries often render the tissues scarred thus making future corrections even more difficult 3 …”