Surgical Decision Making in Complex Facial Gunshot Wound Reconstruction

FACE ◽  
2021 ◽  
pp. 273250162110533
Author(s):  
Collin Nevil ◽  
Eric Heffern ◽  
Wojciech Przylecki ◽  
Brian T. Andrews
Keyword(s):  
Surgical Procedures ◽  
Surgical Techniques ◽  
Gunshot Wounds ◽  
The United States ◽  
Microvascular Reconstruction ◽  
Reconstructive Procedures ◽  
Surgical Decision ◽  
Academic Center ◽  
Lower Mandible ◽  
Upper Third

Introduction: With a rise in gun violence across the United States, facial gunshot wounds (GSWs) present a challenging reconstructive problem that was once seldom encountered in civilian populations. Reconstruction of facial GSW injuries requires a combination of both microvascular and craniofacial surgical techniques. The aim of this study is to explore our experience with facial GSW injuries through an anatomic classification scheme and investigate the surgical techniques necessary to complete such reconstructions. Methods: A retrospective review was conducted at a tertiary academic center. All subjects who suffered facial GSWs and underwent definitive reconstruction at our institution were included. Facial GSWs were classified into 4 distinct anatomical zones of injury: lower (mandible), middle (maxilla and orbit), upper (above the orbit), and multi-zone injury. Microvascular reconstruction was further investigated based on the types of flaps used and the location of flap inset. Surgical outcomes, numbers of procedures, and complications were assessed, and statistical comparisons were made. Results: Thirty-six subjects underwent a total of 322 surgeries. Twenty subjects had multi-zone injury; 16 had single zone injury. Eighteen of the 36 subjects (50%) required microvascular reconstruction. These 18 subjects underwent a significantly increased number of reconstructive procedures ( P = .023). Twenty-six flaps were used, as multiple subjects required >1 flap. Fourteen of the 26 flaps were used in the middle third (54%), 7 in the lower third (27%), and 5 in the upper third (19%). Six flap complications required further surgical revision. On average, multi-zone injuries required more surgical procedures to complete reconstruction ( P = .018). Conclusion: Composite multi-zone facial GSW injuries present a higher degree of reconstructive complexity, and thus often require more surgical procedures, especially when the midface is involved. In our experience, microvascular reconstruction is more often used in multizone injury, and in our series was associated with an increased number of reconstructive procedures.

scholarly journals Overview of Facial Plastic Surgery and Current Developments

2016 ◽  
Vol 02 (01) ◽  
pp. e17-e28 ◽  
Author(s):  
Jessica Chuang ◽  
Christian Barnes ◽  
Brian Wong
Keyword(s):  
Plastic Surgery ◽  
Surgical Techniques ◽  
The United States ◽  
Microvascular Reconstruction ◽  
Facial Plastic Surgery ◽  
Facial Plastic ◽  
The Face ◽  
Craniomaxillofacial Trauma ◽  
Maxillary Surgery ◽  
Injectable Fillers

Facial plastic surgery is a multidisciplinary specialty largely driven by otolaryngology but includes oral maxillary surgery, dermatology, ophthalmology, and plastic surgery. It encompasses both reconstructive and cosmetic components. The scope of practice for facial plastic surgeons in the United States may include rhinoplasty, browlifts, blepharoplasty, facelifts, microvascular reconstruction of the head and neck, craniomaxillofacial trauma reconstruction, and correction of defects in the face after skin cancer resection. Facial plastic surgery also encompasses the use of injectable fillers, neural modulators (e.g., BOTOX Cosmetic, Allergan Pharmaceuticals, Westport, Ireland), lasers, and other devices aimed at rejuvenating skin. Facial plastic surgery is a constantly evolving field with continuing innovative advances in surgical techniques and cosmetic adjunctive technologies. This article aims to give an overview of the various procedures that encompass the field of facial plastic surgery and to highlight the recent advances and trends in procedures and surgical techniques.

scholarly journals Avoiding Complications in Functional and Aesthetic Rhinoplasty

2020 ◽  
Vol 34 (04) ◽  
pp. 260-264
Author(s):  
Marc H. Hohman ◽  
Aurora G. Vincent ◽  
Spencer R. Anderson ◽  
Yadranko Ducic ◽  
Spencer Cochran
Keyword(s):  
United States ◽  
Surgical Procedures ◽  
Surgical Techniques ◽  
The United States ◽  
Nasal Airway ◽  
Top Down ◽  
Aesthetic Rhinoplasty

AbstractHistorically, nasoseptal surgery favoring functional considerations has compromised aesthetic ones, and vice versa, but modern techniques have evolved that allow symbiotic achievement of both goals. Nasoseptal surgery is among the most commonly performed plastic surgical procedures in the United States, and while it is generally well tolerated, there are a few surgical and aesthetic complications of which to be aware. Herein, we review surgical techniques that improve the nasal airway and nasal aesthetics in a top-down approach with a discussion of possible ensuing complications.

scholarly journals Surgery at Cranio-vertebral (CV) Junction: Our Experience of 32 Cases

1970 ◽  
Vol 29 (2) ◽  
pp. 78-84
Author(s):  
FH Chowdhury ◽  
MR Haque ◽  
NKSM Chowdhury ◽  
MS Islam ◽  
Z Raihan ◽  
...  
Keyword(s):  
Surgical Procedures ◽  
Surgical Techniques ◽  
Clinical Findings ◽  
Type I ◽  
College Hospital ◽  
Chiari Malformation Type I ◽  
Female Ratio ◽  
Medical College ◽  
Neoplastic Lesion ◽  
Wide Range

Cranio vertebral (CV) junction is one of the critical sites for surgery. It's anatomy, physiological aspects and pathological involvement varies in a wide range of margins. Common problems are developmental anomalies, traumatic involvement, inflammatory, infective and neoplastic lesion. Management of these problems varies a lot from each other. Aim of the article is to overview the pathologies in this area and to study presentations, investigations, surgical procedures and results of these pathologies. We prospectively analyzed 32 cases of Cranio-vertebral (CV) region surgery in the Department of Neurosurgery Dhaka Medical College Hospital and Mitford Hospital, Dhaka, from 2000 to 2008. In our series, male and female ratio was 7.2:1. Pathologies were atlanto- axial dislocation (AAD), Chiari malformation type –I, schwannoma, meningioma, hydatid cyst and tuberculosis. Common clinical findings were- neck pain, quadriparesis, quadriplegia, hand atrophy, autonomic dysfunction and hypertension. Various types of surgical procedures were done in this series according to the pathology. Death was in 01 case, neurological deterioration seen in one case, 2 cases were neurologically stable and 28 cases (87.5%) improved neurologically where one was non useful improvement (Frankel grade-C). Complete pre operative radiological study is a very important adjunct for a successful surgical result. Proper evaluation of patients with selection of appropriate surgical procedures along with safe surgical techniques are the necessary things for successful surgery in this area. DOI: http://dx.doi.org/10.3329/jbcps.v29i2.7952 (J Bangladesh Coll Phys Surg 2011; 29: 78-84)

scholarly journals Therapeutic efficacy of connective tissue autotransplants with periosteum and platelet rich plasma in the management of gingival recession

2013 ◽  
Vol 70 (7) ◽  
pp. 664-669 ◽  
Author(s):  
Bojan Jovicic ◽  
Zoran Lazic ◽  
Milica Nedic ◽  
Stevo Matijevic ◽  
Aleksandra Gostovic-Spadijer
Keyword(s):  
Connective Tissue ◽  
Surgical Procedures ◽  
Platelet Rich Plasma ◽  
Statistical Significance ◽  
Surgical Techniques ◽  
Gingival Recession ◽  
Contralateral Side ◽  
Test Results ◽  
Keratinized Tissue ◽  
Student’S T

Background/Aim. Gingival recession progression in clinical practaice has influenced the development of various surgical procedures and techniques for solving esthetic imperfections and subjective difficulties coused by gingival recession. The aim of this study was to verify efficacy of surgical procedures and to compare both of surgical procedures through the keratinized tissue width. Methods. The study included 20 teeth with gingival recesion, M?ller class I and II. Ten teeth with gingival recession were treated with connective tissue autotransplants with periosteum in combination with coronary guided surgical flap (CTG group). On the contralateral side 10 teeth with gingival recession were treated with the same surgical procedures but in combination with platelet-rich plasma (CTGPRP group). We measured the keratinized tissue width. For statistical significance we used the Student's t-test. Results. The study reveled a statistical significance in reducing vertical deepress of recession by both used treatments. Root deepness in CTG and CTG-PRP group was 90% and 93.5%, respectively. With both surgical techniques we achieved larger zone of keratinized gingiva but with a wide zone of keratinized tissue in CTG - the PRP group. Conclusion. The concept regeneration technique with PRP and with the stimulating influence of platele activated growth factors results in the regeneration of deep periodontal tissue as an important prerequisite for the successful treatment of gingival recession.

scholarly journals Pediatric Laparoscopic Surgery: Four Years Experience in Dhaka Medical College Hospital

2015 ◽  
Vol 4 (1) ◽  
pp. 11-18
Author(s):  
Tahmina Hossain ◽  
Md Ashraf Ul Huq
Keyword(s):  
Inguinal Hernia ◽  
Surgical Procedures ◽  
Surgical Techniques ◽  
Oral Feeding ◽  
Medical College Hospital ◽  
College Hospital ◽  
Medical College ◽  
Laparoscopic Procedures ◽  
Surgical Conditions ◽  
Care Surgery

Purpose: Laparoscopy is gaining popularity over laparotomy in various surgical conditions. Now a day, an increasing number of diagnostic and therapeutic surgical procedures are being done laparoscopically. The aim of this study was to assess the safety and feasibility of laparoscopy in children.Materials and Methods: This retrospective study was carried out in the Department of Pediatric Surgery of Dhaka Medical College Hospital over a period of 52 (Fifty two) months from June 2009 to August 2013. A total of 123 patients were operated laparoscopically up to 12 years of age for different surgical conditions. Data was collected from the hospital records and analyzed retrospectively.Results: Out of these 123 laparoscopically performed cases, Appendectomy was performed in 39 cases, closure of internal inguinal ring for Inguinal Hernia was done in 36 patients, 20 patients underwent Cholecystctomy, 16 patients had laparoscopic procedures for impalpable Undescended Testis (UDT), 5 patients were operated for Adnexal Mass of which one case was converted into open procedure due to technical difficulties and 1 for Pancreatic Pseudo cyst. Diagnostic Laparoscopy was performed for 2 patients with Biliary Atresia and 4 patients for Ambiguous Genitalia. Median age of the patients was 6.08 years (ranging from 2 months to 12 years of age). The length of post operative hospital stay was 2-3 days. All the laparoscopic procedures for Inguinal Hernia and impalpable UDT were performed as day care surgery. Operative and post operative complications were minimal. Other advantages of the laparoscopic procedures were smaller incisions, incidental diagnosis of other associated pathology, lesser post operative pain, earlier oral feeding, quicker mobilization and a better cosmetic result.Conclusion: With the recent development of laparoscopic surgical techniques and equipments, laparoscopic surgical procedures are becoming popular day by day and can be performed safely for both diagnostic and therapeutic purposes in pediatric surgical patients.J. Paediatr. Surg. Bangladesh 4(1): 11-18, 2013 (January)

Benchmarks for the Durations of Ambulatory Surgical Procedures in Otolaryngology

2011 ◽  
Vol 120 (11) ◽  
pp. 727-731 ◽  
Author(s):  
Neil Bhattacharyya
Keyword(s):  
United States ◽  
Operating Room ◽  
Surgical Procedures ◽  
Ambulatory Surgery ◽  
Secondary Analysis ◽  
The United States ◽  
Tube Placement ◽  
The Mean ◽  
Room Time ◽  
Ambulatory Procedures

Objectives: I undertook to determine benchmarks and variability for the surgical times associated with ambulatory otolaryngological procedures in the United States. Methods: I examined the 2006 release of the National Survey of Ambulatory Surgery and extracted all cases of otolaryngological surgery in which one, and only one, otolaryngological procedure was performed. The mean surgical times and operating room times were determined for each procedure that met reliability criteria for their estimates. A secondary analysis was computed for tonsillectomy and for tonsillectomy plus adenoidectomy according to a patient age of greater than 12 years. Results: An estimated 1.68 ± 0.23 million otolaryngological procedures were analyzed as solitary procedures, including 507,000 cases of myringotomy with ventilation tube placement, 136,000 cases of tonsillectomy, and 429,000 cases of tonsillectomy plus adenoidectomy. The mean (±SE) surgical times were 8.0 ± 0.5, 23.9 ± 1.8, and 20.3 ± 0.8 minutes, respectively. The total operating room times were 17.6 ± 0.9, 48.2 ± 2.0, and 40.7 ± 1.1 minutes, respectively. Septoplasty with turbinectomy was the most common rhinologic procedure performed (48,000 cases analyzed) and had surgical and operating room times of 49.6 ± 4.78 and 79.8 ± 5.8 minutes, respectively. The surgical times for tonsillectomy and tonsillectomy plus adenoidectomy did not differ significantly in magnitude according to standard age cutoffs, although the operating room time was slightly (11.7 minutes) longer for tonsillectomy in patients more than 12 years of age (p = 0.034). Conclusions: The surgical times for the performance of the most common otolaryngological ambulatory procedures are remarkably consistent in the United States. Given the volume and consistency of these surgical procedures, they are ideal candidates for studies of cost and efficiency.

Evaluation and Surgical Treatment of Congenital Craniofacial Deformities

Neurosurgery ◽  
1978 ◽  
Vol 2 (2) ◽  
pp. 148-153 ◽  
Author(s):  
Jack E. Maniscalco ◽  
Mutaz B. Habal
Keyword(s):  
United States ◽  
Congenital Malformations ◽  
Surgical Techniques ◽  
Neurological Impairment ◽  
The United States ◽  
Mortality Rates ◽  
Craniofacial Surgery ◽  
Brain Malformation ◽  
Working Together ◽  
Method Of Evaluation

Abstract The field of craniofacial surgery has rapidly developed over the last decade in the United States and abroad. Congenital malformations heretofore considered hopeless are now being corrected by a team of specialists working together in the cranial-facial junction. The evaluation of patients for craniofacial surgery must include consideration of associated neurological impairment, and in certain syndromes the incidence of brain malformation and mental retardation are extremely high. The method of evaluation and the various surgical techniques are presented. Mortality rates from this surgery have ranged from 0 to 5%, according to the severity of the deformities.

Lympedema Therapies

2021 ◽  
Author(s):  
Shailesh Agarwal ◽  
Catherine Wu
Keyword(s):  
Lymph Node ◽  
Drainage Basin ◽  
Parasitic Infection ◽  
Surgical Techniques ◽  
Lymphatic Drainage ◽  
The United States ◽  
Secondary Lymphedema ◽  
Complete Decongestive Therapy ◽  
Infection Treatment ◽  
Lymph Node Transfer

Secondary lymphedema refers to a condition in which the affected extremity develops progressive hypertrophy due to lymphatic fluid retention. Worldwide, secondary lymphedema is most often associated with parasitic infection; within the United States, secondary lymphedema is most often caused by surgical disruption of the lymphatic drainage basins due to cancer surgery and/or radiation. For patients with lymphedema secondary to parasitic infection, treatment of the offending infectious organism (Wuchereria bancroftii) is critical. For patients with surgical disruption of the lymphatic drainage basin(s), patients are first managed non-operatively with compression and manual lymphatic drainage massage. Over the past decade, surgical techniques have been developed and implemented to improve lymphatic drainage for patients with post-surgical secondary lymphedema. These procedures, including lymphovenous bypass or vascularized lymph node transfer, are aimed at reconstituting lymphatic drainage and reducing lymphatic retention to alleviate early lymphedema. An appreciation of the underlying physiology responsible for secondary lymphedema, and diagnosis and management is required to provide timely and appropriate care for these patients. This review contains 2 tables, 4 figures, and 32 references Keywords: lymphedema, lymphedema treatment, secondary lymphedema, complete decongestive therapy, lymphovenous bypass, vascularized lymph node transplantation, debulking surgery, ICG lymphangiography, lymphedema staging

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