Facial plast Surg 2019; 35(06): 578-583
DOI: 10.1055/s-0039-1700879
Original Article
Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Facial Gunshot Wounds

Angela S. Volk
1  Department of Plastic Surgery, Baylor College of Medicine, Houston, Texas
2  Department of Plastic Surgery, Texas Children's Hospital, Houston, Texas
,
Tom Shokri
3  Department of Otolaryngology, Penn State Health Milton S. Hershey Medical Center, Hershey, Pennsylvania
,
Mofiyinfolu Sokoya
4  Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
,
Yadranko Ducic
4  Otolaryngology and Facial Plastic Surgery Associates, Fort Worth, Texas
,
Larry H. Hollier Jr.
1  Department of Plastic Surgery, Baylor College of Medicine, Houston, Texas
2  Department of Plastic Surgery, Texas Children's Hospital, Houston, Texas
› Author Affiliations
Further Information

Publication History

Publication Date:
29 November 2019 (online)

Abstract

Craniomaxillofacial gunshot injuries, resulting from assault, suicide attempts, and accidental trauma, represent a major public health dilemma in the United States. Due to the extent of injury and resulting osseous and soft tissue loss, facial gunshot wounds pose a unique challenge to the reconstructive surgeon. Initial management should use advanced trauma life support principles with the goal of patient stabilization. Acute operative management should center around wound decontamination, debridement, and temporary closure. Historically, definitive surgical management focused on delayed reconstruction secondary to high rates of wound infections, necrosis, and ischemia. With improvements in imaging modalities, the advent of virtual surgical planning, and the popularization of microvascular free flaps, contemporary methods have shifted toward earlier more definitive reconstruction. Autologous free tissue transfer has resulted in a decrease in hospital stay and the number of overall surgeries. Importantly, due to the variability in injury pattern and complexity in reconstruction, a systematic approach toward intervention is needed to mitigate complications and optimize overall functional and aesthetic outcomes.