Facial Soft Tissue Injury and Healing

Sydney C. Butts, MD, FACS

No patient who is the victim of facial trauma expects the terrible set of events that result in their injury. The acute nature of the event requires fast and accurate assessment of the injury and an empathic approach to the patient to earn their trust and understanding of the treatment plan. Knowledge of the mechanism of the soft tissue injury is imperative for the surgeon to fully understand its complexity. The superficial aspect of the injury may not reflect deeper tissue damage. This knowledge also reveals the causative factors resulting in the injury, be it an animal or human bite, stab wound, gunshot wound, or accidental cause. In some of these cases, especially among adults, interpersonal violence is the root cause. Domestic violence, self-inflicted wounds, and injuries from violent altercations with guns or knives are the underlying causes that stem from deeper societal problems. Physicians are positioned to see the end result of numerous social factors that can lead to facial trauma. It is for this reason that physicians from many specialties including surgery, emergency medicine and psychiatry, along with government officials, community leaders, and members of the public have framed interpersonal violence as a significant public health problem. As such, primary prevention strategies have been proposed to understand the societal stressors, mental health concerns, and other risk factors that lead to trauma.

This issue of Facial Plastic Surgery is a comprehensive review of soft tissue injuries by facial subsite. Articles will also address massive soft tissue trauma requiring free flap reconstruction or the most severe cases that are candidates for facial transplantation. Continued U.S. involvement in the war in Afghanistan and the sophisticated weapons used in combat require an understanding of ballistic injuries which must be addressed by military surgeons. Surgeons in the U.S. encountering gunshot victims also benefit from this knowledge which will be reviewed in an article on ballistic injuries. Finally, we will address the unique presentations and treatment approaches for children with soft tissue trauma of the face. The impact of ongoing facial growth and the possibility of secondary deformity may require different treatment decisions in this group compared with adults.

The excellent articles in this issue provide evidence-based treatment guidelines that address the spectrum of facial injuries encountered. As surgeons, we know the unique concerns and fears that patients experience who have a facial scar. It is important to keep in mind the emotional stress associated with injuries of the face which must also be addressed during the patient's recovery.

Publication History

Article published online:
20 July 2021