General Surgeon’s Challenge: Primary Reconstruction of High-Velocity Facial Trauma

Abstract

Background: Facial wounds are often seen in the emergency department. Whether isolated or associated with cranial injuries or poly-trauma, they can have a significant impact on the patient’s facial aesthetics and consequently, their eminent psychological states.
Case presentation: A 63-year-old man was referred to our emergency department with an extensive facial injury, which occurred when a grinder disc for working with metal broke, while he was working at home and hit him with high velocity in the face. The patient was hemodynamically stable with a disfiguring, profusely bleeding wound of the maxilla and mandible. One tooth in the lower jaw had been broken and one was missing. The wound was closed with synthetic, resorbable, interrupted sutures in two layers (the inner layer was buccal mucosa, and the other layer was only the skin).
Discussion and conclusion: The extent of damage to soft tissue depends on the type and velocity of the object. Proper wound treatment is necessary, including thorough irrigation, removal of foreign bodies, tension-free closure, reconstruction of anatomical landmarks and correct follow-up. Wound healing starts shortly after the initial tissue trauma, and can take up to several months to complete. Disorder in hemostasis and uncontrolled inflammation can lead to an unfavorable outcome. Facial injuries are treated by general surgeons in only 0.5% of cases, with plastic surgeons, oral and maxillofacial surgeons, and otolaryngologists/head and neck surgeons being the most common specialties. Anatomic, diagnostic, and handling considerations should be analyzed to achieve the best results and minimize late post traumatic deformities. Complex facial reconstruction is possible when treated by an experienced general surgeon.