Management of Avulsive Soft Tissue Ballistic Facial Injuries

Yang Ding; Winston R. Owens; Diego M. Quirarte; Olivia G. Leonovicz; Kerry P. Latham

doi:10.1055/s-0045-1801876

Seminars in Plastic Surgery, Table of Contents

Semin Plast Surg 2025; 39(01): 049-056
DOI: 10.1055/s-0045-1801876

Review Article

Management of Avulsive Soft Tissue Ballistic Facial Injuries

Authors

Yang Ding

¹Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas

²Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas
Winston R. Owens

¹Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas

²Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas
Diego M. Quirarte

¹Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas

²Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas
Olivia G. Leonovicz

¹Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
Kerry P. Latham

³Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland

Abstract

Ballistic facial injuries are rare yet challenging cases for plastic surgeons that often comprise of avulsive tissue loss. They require in-depth assessment and staged reconstruction after patient stabilization. Each anatomic region of the face holds specific considerations that should be prioritized during reconstruction. Soft tissue repair techniques of facial gunshot wounds are widely variable and range from primary closure to multistage free flaps. Large, devastating facial defects after ballistic trauma previously posed significant challenges for reconstruction; however, advances in composite tissue transplant and allografts have expanded plastic surgeons' reconstructive arsenals. The goal of this review is to focus on the fundamentals of soft tissue management and reconstruction after ballistic facial injury. Through sound surgical principles, patients may achieve optimal aesthetic and functional outcomes despite experiencing highly morbid facial ballistic injuries.

Keywords

ballistic facial injuries - craniofacial trauma - soft tissue reconstruction - composite transplantation

Full Text

References

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