Citation

Vaca EE, Bellamy JL, Sinno S, Rodriguez ED. Plast. Reconstr. Surg. Glob. Open 2018; 6(3): e1693.

Affiliation

Department of Surgery, Division of Plastic and Reconstructive Surgery, Northwestern Memorial Hospital, Chicago, Ill.; Wyss Department of Plastic Surgery, New York University Langone Medical Center, New York, N.Y.; and Private Practice, TLKM Plastic Surgery, Chicago, Ill.

Copyright

(Copyright © 2018, Lippincott Williams and Wilkins)

DOI

10.1097/GOX.0000000000001693

PMID

29707453

PMCID

PMC5908512

Abstract

BACKGROUND: High-energy avulsive ballistic facial injuries pose one of the most significant reconstructive challenges. We conducted a systematic review of the literature to evaluate management trends and outcomes for the treatment of devastating ballistic facial trauma. Furthermore, we describe the senior author's early and definitive staged reconstructive approach to these challenging patients.

METHODS: A Medline search was conducted to include studies that described timing of treatment, interventions, complications, and/or aesthetic outcomes.

RESULTS: Initial query revealed 41 articles, of which 17 articles met inclusion criteria. A single comparative study revealed that early versus delayed management resulted in a decreased incidence of soft-tissue contracture, required fewer total procedures, and resulted in shorter hospitalizations (level 3 evidence). Seven of the 9 studies (78%) that advocated delayed reconstruction were from the Middle East, whereas 5 of the 6 studies (83%) advocating immediate or early definitive reconstruction were from the United States. No study compared debridement timing directly in a head-to-head fashion, nor described flap selection based on defect characteristics.

CONCLUSIONS: Existing literature suggests that early and aggressive intervention improves outcomes following avulsive ballistic injuries. Further comparative studies are needed; however, although evidence is limited, the senior author presents a 3-stage reconstructive algorithm advocating early and definitive reconstruction with aesthetic free tissue transfer in an attempt to optimize reconstructive outcomes of these complex injuries.

Language: en