Citation

Tomassini L, Ascani G, Mancini P, Cacaci C, Scendoni R. Int. J. Emerg. Med. 2023; 16(1).

Copyright

(Copyright © 2023, Holtzbrinck Springer Nature Publishing Group)

DOI

10.1186/s12245-023-00572-3

PMID

unavailable

Abstract

BACKGROUND: Facial gunshot wounds present a complex challenge to both medical professionals and victims with significant physical, psychological, and economic implications for those who suffer these types of injuries. Reconstructive surgery offers satisfactory aesthetic and functional outcomes, improving a patient's quality of life. In these cases, the surgical procedure may encompass additional phases beyond those initially identified based on the type of wound and the extent of tissue destruction. As a result, each case necessitates thorough evaluation to determine an appropriate strategy. Nonetheless, it is worth noting that the outcomes achieved in terms of both aesthetics and functionality in this domain have the potential to be excellent. Case presentation: A 66-year-old man attempted suicide with a shotgun, causing severe facial injuries and fractures. He had a history of depression and was taken to the emergency department promptly. CT scans revealed brain and facial bone injuries, and he underwent surgery to control bleeding and tracheostomy. Postoperative recovery was successful. The patient's condition stabilized, and he was discharged after 10 days. Follow-up visits showed gradual healing. Despite an offer for further facial reconstruction, he declined, satisfied with the achieved results.

CONCLUSIONS: The present case report is intended to support the argument that effective facial reconstruction should be considered in the medico-legal assessment. It could be beneficial to introduce a new classification system and personalized evaluation methods with careful consideration given to treatment costs (which can be very high) and expected results. Since reconstructive surgery modifies damage and impacts the long-term costs of permanent impairments, its inclusion in the decision-making process would promote improved personalized care. © 2023, The Author(s).

Language: en

Keywords

human; male; aged; case report; depression; suicide attempt; gunshot injury; clinical article; hospital admission; medicolegal aspect; sedation; bleeding; emergency ward; pH; treatment refusal; follow up; hospital discharge; postoperative period; patient satisfaction; heart rate; antibiotic agent; face injury; cost control; face fracture; face surgery; infusion fluid; blood pressure; swallowing; oxygen saturation; oxygen tension; Article; comminuted fracture; mandible; tracheostomy; hemoglobin; intubation; arterial gas; medical history; clinical assessment; vital sign; mouth cavity; soft tissue; emergency surgery; feeding; carbon dioxide tension; facial bone; eye; antibiotic prophylaxis; orbit fracture; hard palate; x-ray computed tomography; reconstructive surgery; ammunition; maxillary sinus; skin flap; fraction of inspired oxygen; Cost of firearm injuries; ethmoid bone; Facial gunshot wounds; Medico-legal assessment; orbital floor; Permanent impairments; Reconstructive surgery