Application of Modified Kite Flap in Reconstruction of Facial Wounds After Operation and Case Series.

Our team used a new kite flap preparation method to repair wounds after the removal of a benign facial tumor with satisfactory aesthetic results. Thus, this modified kite flap has significant value in facial trauma repair.

MOXAIC: A classification of major maxillofacial wounds, concerning 310 cases.

INTRODUCTION: Although classification for facial fractures have been extensively described in the literature, corresponding systems for major maxillofacial wounds (MMW) are few. We would like to present MOXAIC: a new classification system for MMW. MATERIAL AND METHODS: A retrospective study of 310 patients with MMW who underwent emergency operation between January 2005 and December 2016. MMW was defined as a facial wound longer than 10 cm, which includes damage to the craniofacial bone or other important facial structures such as the carotid arteries, facial nerves, parotid gland, Stensen's duct, or the eye. All the patients were followed at least 36 months. RESULT: Based on the shape of the wound, the severity, and the mechanism of injury we were able to classify the MMW into five types: O, X, A, I, C. For each wound type we then looked at the treatment required and the outcome, objectively classified as good, satisfactory, or poor, concerning anatomical correction, aesthetics, and function. + Type OCircumferential wound: 81.6% result good. + Type X-Oblique wound: only 48.1% good, despite initial multidisciplinary approach. + Type A-Transverse facial wound: 78.1% good. + Type I-Direct wound: Immediate airway management and hemorrhage control are important. 48.8% good. + Type CCut wound: 88.1% good. The above classification was named MOXAIC which is a mnemonic of 'Maxillofacial' and the five wound types: O, X, A, I, C. CONCLUSION: This classification is highly reproducible, easy to use, and allows quick treatment work up and prognosis. However, this classification requires further specialist review and study.

Soft Tissue Injuries Including Auricular Hematoma Management.

Facial trauma accounts of 7% to 10% of emergency department visits in the United States every year. The management of facial soft tissue trauma is an essential skill for the facial plastic surgeon. Understanding preoperative evaluation, repair/management of concomitant injuries, postoperative care, and scar treatment help the facial plastic surgeon obtain the best functional and aesthetic results for the patient. Treating the face by subunit and avoiding common pitfalls is the key to achieving optimal results. This article can serve as a basis for surgical pearls and considerations when evaluating and repairing facial soft tissue trauma.

Facial Vascular Events and Tissue Ischemia: A Guide to Understanding and Optimizing Wound Care.

The Complications in Medical Aesthetics Collaborative (CMAC) is a nonprofit organization established to promote best patient outcomes through educating clinicians in the prevention, diagnosis, and management of complications that can arise following nonsurgical cosmetic procedures. The organization is a global community sharing information, learning, experience, and data to promote best practices. This article explores how dermal filler vascular events can cause tissue ischaemia leading to a facial wound. Ideally, vascular events will be diagnosed early and amenable to reversal with hyaluronidase if caused by a cross-linked hyaluronic acid. If there is significant and extensive hypoxia to the area, there is delayed diagnosis, or the injected product cannot be reversed, the management should center around optimizing wound care. Both simple and complex wounds will benefit from good care. Patients seek aesthetic treatments to improve how they look and can be vulnerable to poor outcomes. Wounds, if not treated appropriately, can result in permanent scarring or other sequalae, such as post-inflammatory hyperpigmentation. There are many publications addressing vascular events in aesthetic practice, but providing optimal care for facial wounds is not addressed.

Reconstrucción labial por mordedura canina en una anciana / Labial reconstruction due to a dog bite in an elderly woman

Se presenta el caso clínico de una anciana de 80 años de edad con antecedentes de demencia senil, quien acudió acompañada de sus hijos a la consulta de Emergencia del Hospital Provincial Docente Clinicoquirúrgico Saturnino Lora Torres por presentar mordedura de un perro en la región labial. A la paciente se le realizó lavado de la herida, desbridamiento y profilaxis, seguidos de la confección de colgajos locales combinados y sutura inmediata. Los resultados cosméticos y funcionales fueron catalogados como favorables.

The case report of an 80 years elderly woman with history of Alzheimer´s is presented, who went along with her children to the Emergency Service of Saturnino Lora Torres Teaching Clinical Surgical Provincial Hospital due to a dog bite in the labial region. The wound cleaning, debridement and prophylaxis was carried out to the patient, followed by making combined local flaps and immediate suture. The cosmetic and functional results were classified as favorable.

Reconstrução de lesão em lábio superior por mordedura animal em criança / Reconstruction for injury in upper lip biting in animal in child

Os ferimentos ocasionados por mordeduras animais são comuns e de importância na saúde pública, tendo consequências, como desfiguração, infecção e, até mesmo, a morte em casos mais graves. A conduta frente a essas lesões é controversa, principalmente do ponto de vista do fechamento primário da ferida da profilaxia de doenças infecto-contagiosas, originadas a partir do contato da saliva do animal com a ferida. O atendimento desses doentes na urgência consiste no controle da infecção, reabilitação funcional e, consequentemente, estética, a fim de minimizar danos psíquicos e possibilitar retorno ao convívio social. O presente trabalho relata o caso de ferimento em lábio superior de uma criança decorrente de agressão por mordida canina. A reconstrução foi realizada através da rotação de retalho rombóide da mucosa oral bem como do avanço retilíneo do retalho cutâneo associado aos triângulos de Descarga. Além disso, foi instituída uma antibioticoterapia específica. Dessa maneira, foi obtido um resultado estético e funcional satisfatório, sem complicações infecciosas pós-operatórias ou deiscências de suturas... (AU)

Injuries caused by dog bites are common and have importance in public health, with consequences such as disfigurement, infection and even death in severe cases. The correct approach to these lesions is controversial, especially in primary closure of the point of view of the wound and prophylaxis of infectious diseases originating from the animal's saliva contact with the wound. The care of these patients in the emergency consists in controlling infection, functional rehabilitation and consequently aesthetics in order to minimize possible psychological damage and return to social life. This paper reports the injury case in upper lip of a child resulting from aggression by canine bite. The reconstruction was carried out by retail rhomboid oral mucosa rotation and straight forward skin flap associated with the discharge of triangles. Moreover, a particular antibiotic was introduced. Thus it was obtained a satisfactory aesthetic and functional results without infectious postoperative complications or dehiscence of sutures... (AU)

Facial dog attack injuries.

The exposed position of the face makes it vulnerable to dog bite injuries. This fact combined with the short stature of children makes them a high-risk group for such attacks. In contrast to wounds inflicted by assaults and accidents, dog bite wounds are deep puncture type wounds compounded by the presence of pathologic bacteria from the saliva of the attacking dog. This, combined with the presence of crushed, devitalized tissue makes these wounds highly susceptible to infection. Key to successful management of such wounds are meticulous cleansing of the wound, careful debridement, primary repair, appropriate antibiotic therapy, and rabies and tetanus immunization where indicated. This review presents an overview of the epidemiology, presentation, management of such emergencies, and the recent advances in the care of such patients.

Emergency plastic treatment in children's facial injury / 中华医学美学美容杂志

Objective To analyze and summarize the features of children's facial wound and to share the emergency treatment experiences.Methods An retrospective study was conducted on the pathogenesis,age distribution,emergency treatment methods and complications in 1407 children (under 15 years of age) during recent 8 years (from January 2004 to December 2011).Results In this study the major facial wound type was simply lacerations (1196/1407,85.0 ％),and the most common wound cause was trumbling injury (1154/1407,82.0 ％).The T area was the easiest injured,successively,forehead (562/1407,39.9％),chin (211/1407,15.0％),lips (196/1407,13.9％) and nose (95/1407,6.8％).Here were 2 peaks in age distribution which were 2 and 5 years of age,respectively.Pleased outcome would be found while normalized plastic means were taken.After 3 to 6 months following up,there were 5 infection cases,27 cases healed with hypertrophic scars,and 7 cases with traumatic tattoos in wound location.Conclusions The most common wound type is simply laceration.2 and 5 years of age are two of the highest risk stages.It is necessary to act up to plastic surgery principles and take children's particularity into account when emergency treatment,and to do our best to minimize the scar in the first operation time.

Degloving facial injury treated with hydroconductive dressing.

COMPLEX, OPEN MAXILLOFACIAL FRACTURES ARE OFTEN ACCOMPANIED BY EXTENSIVE CONTAMINATION, CRUSH, OR AVULSION OF THE OVERLYING SOFT TISSUE, THERE HAVE BEEN TWO ALTERNATIVES TO TREATMENT: either radical debridement of all contaminated tissue, fixation of the underlying fractures, and soft tissue closure by pedicle flap or graft is done; or more conservative debridement is repeated multiple times until the contaminated tissue is removed and fracture fixation is deemed safe. Debridement is usually accomplished by sharp debridement or with high-pressure intermittent irrigation or some combination of both modalities. The problems with this standard treatment in the face are that facial features may be distorted, superficial branches of the facial and/or trigeminal nerve can be inadvertently sacrificed (even with the use of nerve stimulators), and scarring can distort contours and radically change facial appearance. A serious facial degloving injury with necrotic malodorous tissue and no clear anatomical delineations demanded special attention. The purpose of this report is to demonstrate the management of a soft tissue avulsive contaminated injury of the face with underlying maxillofacial fractures.