Significance of microvascular reconstruction in treatment of gunshot wounds of the face

Abstract

Efficient Combat Casualty Care System aims at saving lives of the wounded as well as regaining their quality of life at the highest possible level. This article provides the data on using revascularized grafts to repair gunshot defects, presents data on the proportion, cause, severity and nature of facial wounds. We also give here recommendations on treatment modalities in these patients. In between the 1 March and the 1 November 2022 in the Center of maxillofacial surgery and dentistry of Main Military Hospital named after N.N. Burdenko we performed 54 reconstructions, 47 of which were microvascular utilizing 49 free flaps. Despite good vasculature in the face, it lacks soft tissues for closing vast gunshot defects. Damaged with high energy projectiles the tissue of the face gives poor bedding to the alloplastic implants, resulting in their exposure. Contemporary level of microvascular technique gives the plastic surgeon an efficient instrument for closing the gunshot defects in early wound healing period. We do not recommend using regional tissues to treat gunshot defects in the first place, because they are usually insufficient to fully resolve the defect, and at the same time it leads to a violation of the anatomy and even greater deformation of the soft tissues surrounding the defect. Titanium re constructive and mesh plates are associated with high rate of exposure in the bone defects and are not to be recommended for the reconstruction either.