Microsurgical reconstruction of complex maxillofacial gunshot wounds: Outcomes analysis and algorithm.
Adolescent
Adult
Aged
Algorithms
Analysis of Variance
Chi-Square Distribution
Cohort Studies
Databases, Factual
Emergency Treatment
Female
Follow-Up Studies
Graft Survival
Humans
Injury Severity Score
Logistic Models
Male
Maxillofacial Injuries
/ diagnosis
Middle Aged
Minimally Invasive Surgical Procedures
/ methods
Plastic Surgery Procedures
/ methods
Retrospective Studies
Risk Assessment
Surgical Flaps
/ transplantation
Time Factors
Treatment Outcome
Wound Healing
/ physiology
Wounds, Gunshot
/ diagnosis
Young Adult
Journal
Microsurgery
ISSN: 1098-2752
Titre abrégé: Microsurgery
Pays: United States
ID NLM: 8309230
Informations de publication
Date de publication:
Jul 2019
Jul 2019
Historique:
received:
03
05
2018
revised:
28
11
2018
accepted:
12
12
2018
pubmed:
25
1
2019
medline:
16
1
2020
entrez:
25
1
2019
Statut:
ppublish
Résumé
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. 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. 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. 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.
Sections du résumé
BACKGROUND
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
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
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
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.
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
384-394Informations de copyright
© 2019 Wiley Periodicals, Inc.