Seminars in Plastic Surgery最新文献

Mass casualty incidents (MCIs) can transpire through a multitude of mechanisms, the most common of which are mass shootings. These events result in several injuries and/or deaths and often strain or overwhelm available medical resources. Since the injuries that result from these incidents vary in type and severity, effective identification and triage is needed. Bystanders, first responders, ancillary medical staff, nurses, and physicians are integral in managing the victims, and efficient communication is required to provide timely and adequate medical care. From soft tissue injury and burns to facial trauma, the craniomaxillofacial surgeon is a crucial member of the team and their expertise is vital in triaging and in treating the injured. This review discusses triage, patterns of injury, and the role of craniomaxillofacial surgeons in MCIs.

Pediatric ballistic injuries are a public health crisis in the United States. Younger children are more likely to sustain craniofacial injuries, which are associated with higher mortality rates. An understanding of the timeline of craniofacial development and the variation in pediatric facial proportions over time is important to guide further treatment of these patients. Management of these patients includes initial stabilization according to the Advanced Trauma Life Support protocol followed by management of time-sensitive injuries. Ballistic injuries often result in soft tissue and bone defects, requiring fixation and coverage. As children experience faster rates of bone healing, fixation should be done promptly. Soft tissue coverage is dependent on the size of the defect; whereas smaller wounds can be closed with primary closure or local tissue rearrangement, larger wounds may require free tissue transfer.

Firearm-related trauma in the United States is a public health crisis with increasing rates of gun-mortality annually. Within the United States, minorities are disproportionally affected by firearms, and nonmedical factors play a significant role in predicting an individual's risk for experiencing gun trauma. Devastating injuries associated with head gunshot wounds often require care from multidisciplinary teams to achieve favorable outcomes. Despite collaborative care, complications after firearm injuries transcend beyond physical damage and result in lasting psychological, social, and economic burdens. This article reviews ballistic terminology, epidemiology, social determinants of health, and the quality of life of gunshot wound survivors.

Gunshot wounds to the head result in significant morbidity with a low rate of survival. Current treatment recommendations for penetrating traumatic brain injury (pTBI), established in 2001, are based off techniques used in recent Middle Eastern conflicts. However, many advancements in care have been made and updates in official pTBI treatment guidelines are being formulated. While some penetrating brain injury patients are managed nonoperatively due to poor prognosis, many undergo emergent interventions and delayed reconstruction by various surgical subspecialists. This article explores the management of pTBI and the collaborative roles of neurosurgeons, ophthalmologists, and plastic surgeons.

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.

Lip reconstruction is challenging for plastic surgeons due to the unique functionality and aesthetic complexity of the lips within the lower third of the face. The etiology of lip defects varies from congenital to acquired causes of origin. The most common acquired cause of lip defects is resection of malignancy. Defects can present as various shapes and sizes and may affect any location on the lip. Each defect requires a full workup, and algorithms such as the rule of thirds, are commonly used to swiftly identify optimal reconstructive options. The goal of lip reconstruction is to ensure oral competence while restoring intricate, cutaneous landmarks. The approach to lip reconstruction makes use of many rungs of the reconstructive ladder. This article primarily focuses on repairing lip defects secondary to Mohs surgery; however, the reconstructive methods discussed are useful for lip defects of all causes. This article will review lip defect evaluation, reconstructive methods, common complications, and adjuvant therapies to ensure optimal lip function and cosmesis.

For proper reconstruction of scalp and forehead defects following Mohs micrographic surgery (MMS), knowledge of the unique anatomy and aesthetic importance of these structures is necessary to restore function and appearance. However, the inflexibility, convexity, and hair-bearing nature of the scalp and forehead can make reconstruction challenging. Detailed planning and precise management are essential to achieve adequate reconstructive results. Defect size, location, prior radiation history, and symmetry of hairlines should be taken into consideration during planning, and the simplest reconstructive technique should be utilized whenever feasible. This review will discuss the reconstructive options available for acquired defects of the scalp and forehead.

Judging surgical quality within facial reconstruction is challenging for many reasons. Factors beyond the completion of surgery influence the quality of the result, demanding the surgeon to predict and mitigate potential confounders of quality. This skill is honed over years of experience and practice. Patient satisfaction, risk profile, and the ideals within the field are central to understanding the quality of the outcome.

The nose maintains a central importance in both functional and aesthetic human anatomy. With such importance comes numerous possible defects with equally plentiful techniques available for repair. One of the most common causes for nasal reconstruction is Mohs micrographic surgery to excise basal and squamous cell carcinomas. Generally, these procedures create small defects which can be repaired via skin graft or flaps with possible assistance from biologic agents.