J Korean Med Assoc.  2018 Dec;61(12):724-731. 10.5124/jkma.2018.61.12.724.

Microsurgical reconstruction of posttraumatic large soft tissue defects on face

• Baek W
• Song SY
• Roh TS
• Lee WJ

• KMID: 2429336
• DOI: http://doi.org/10.5124/jkma.2018.61.12.724

Abstract

Our faces can express a remarkable range of subtle emotions and silent messages. Because the face is so essential for complex social interactions that are part of our everyday lives, aesthetic repair and restoration of function are an important tasks that we must not take lightly. Soft-tissue defects occur in trauma patients and require thorough evaluation, planning, and surgical treatment to achieve optimal functional and aesthetic outcomes, while minimizing the risk of complications. Recognizing the full nature of the injury and developing a logical treatment plan help determine whether there will be future aesthetic or functional deformities. Proper classification of the wound enables appropriate treatment, and helps predict the postoperative appearance and function. Comprehensive care of trauma patients requires a diverse breadth of skills, beginning with an initial evaluation, followed by resuscitation. Traditionally, facial defects have been managed with closure or grafting, and prosthetic obturators. Sometimes, however, large defects cannot be closed using simple methods. Such cases, which involve exposure of critical structures, bone, joint spaces, and neurovascular structures, requires more complex treatment. We reviewed and classified causes of significant trauma resulting in facial injuries that were reconstructed by microsurgical techniques without simple sutures or coverage with partial flaps. A local flap is a good choice for reconstruction, but large defects are hard to cover with a local flap alone. Early microsurgical reconstruction of a large facial defect is an excellent choice for aesthetic and functional outcomes.

Keyword

Facial Injuries; Wounds and injuries; Surgery, plastic; Microsurgery

MeSH Terms

Classification
Congenital Abnormalities
Facial Injuries
Humans
Interpersonal Relations
Joints
Logic
Microsurgery
Resuscitation
Surgery, Plastic
Sutures
Transplants
Wounds and Injuries

Figure

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  Figure 1 An early version of the reconstructive ladder. Adapted from Neligan PC, et al. Plastic surgery: principles. Vol. 1. London: Elsevier; 2012, with permission from Elsevier [2].

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  Figure 2 Classification of facial aesthetic unit. Adapted from Gonzalez-Ulloa M. Plast Reconstr Surg 1957;19:350 [5].

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  Figure 3 Measurement of defect area by ImageJ software (NIH, Bethesda, MD, USA). Informed consent was obtained from the patient.

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  Figure 4 Scalp reconstruction with anterolateral thigh free flap. (A) Preoperative wound, (B) after debridement, (C) immediate postoperative, and (D) after 24 months. Informed consent was obtained from the patient.

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  Figure 5 Forehead reconstruction with anterolateral thigh free flap. (A) Preoperative wound, (B) first reconstruction using anterolateral thigh free flap and full thickness skin graft (FTSG), (C) postoperative bulky flap and Ectropion of left eyelid, (D) secondary revision by FTSG, bulky flap reduction and microfat graft, (E) third revision by FTSG and bulky flap reduction, and (F) after 60 months follow up state. Informed consent was obtained from the patient.

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  Figure 6 Nasal reconstruction. (A) After excision state and (B) reconstruction with radial forearm free flap. Informed consent was obtained from the patient.

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  Figure 7 Cheek reconstruction. (A) After tumor removal, opening to oral and nasal space, (B) flap design with skin, nasal and oral area, (C) after 6 months follow-up, and (D) oral side skin paddle. Informed consent was obtained from the patient.

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  Figure 8 Chin reconstruction. (A,B) Preoperative wound after debridement, bone exposure and (C,D) after 24 months, minor revision with debulking flap and scar revision. Informed consent was obtained from the patient.

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