Abstract

This article presents our experience with regional flaps in the treatment of facial soft-tissue defects and deformities in 33 patients with various facial injuries from warfare during the period from 1986 to 1999, Thirty-two males and 1 female aged between 8 and 53 years (mean 23.18 Sears) were treated with facial soft-tissue injuries from high velocity projectiles and varying degrees of associated hard-tissue injuries. Bullets were the most common cause (70), followed by injuries from shrapnel (21), land mines (6), and breech blocks (3), The perioral region was involved in 15 cases (45), the midface and cheeks were involved in 13 cases (39), and the periorbital area was involved in 5 cases (15), All soft-tissue injuries were treated primarily by debridement and primary closure and by combining, modifying, and tailoring standard regional flap techniques to fit the location of the injury and compensate for the extent of tissue loss. These procedures consisted basically of local-advancement or rotation-advancement flaps, used in conjunction with pedicled fat or subcutaneous supporting flaps, nasolabial, cheek, cervical, Dieffenbach, and;Abbe-type flaps. Scar revision, tissue repositioning, and lengthening procedures, such as W. V-Y, Z, or multiple Z-plasty techniques were also used both primarily and secondarily. Revisions and secondary operations were done in 48 of the patients, Initial healing of the flaps,vas favourable in 76 of the patients. Postoperative discharge from the suture sites was seen in 24 of the patients, but this usually resolved within several weeks using daily irrigation, and these cases underwent scar revision subsequently, None of the soft-tissue flaps sloughed or developed necrosis, Form and function of the soft-tissue reconstructed regions usually recovered within one year postoperatively, The aesthetic results obtained were favourable. None required facial nerve grafting as only the terminal branches were injured in our cases and functional recovery was acceptable, Application of local tissue transfer procedures in our series of facial warfare injuries yielded acceptable tissue form, texture, and colour match, especially when these procedures were used in combination, and tailored to surgically fit the individual case. Moreover, application of these procedures is relatively easy and postoperative morbidity is limited, provided the general condition of the patient is stable, and the surgical techniques used have goad indications and flap principles. (C) 1999 European Association for Cranio-Maxillofacial Surgery.