FACIAL WOUND ASSESSMENT KIT

Facial wounds are a frequent reason for emergency room visits. The goals of laceration repair are to achieve hemostasis, avoid infection, restore function to the involved tissues, and achieve optimal cosmetic results with minimal scarring. Therefore, these cases are most appropriately managed by plastic surgeons who have a thorough knowledge of anatomy, aesthetic sense, and meticulous expertise in atraumatic tissue manipulation, combined with the surgical skill to repair any structure. You need to know what to do and what not to do : whether to suture or leave open. What local anesthesia to use and how. What equipment to use (and have it available beforehand). Whether to give antibiotic therapy and what kind. How to avoid aesthetic or functional after-effects. Which dressing to use depending on the state of the wound. This article will serve as an aid to wound management and review repair techniques for high-risk areas of the face.

213 A Novel, Cost-Effective and Convenient Model for Simulating Facial Wound Repair

Introduction We describe the use of a novel synthetic simulation pad for learning complex facial wound management including local flaps. The simulation pad is a cost effective and convenient model of facial wounds. We have compared the use of animal tissue to the simulation pad in the context of a workshop for surgical trainees and collected feedback from delegates. Methods Feedback was collected from 14 of 16 attending delegates. Results It was clear from feedback that animal tissue is not an ideal model of facial wounds with 71% of delegates stating that they did not consider it to be high-fidelity. The synthetic pad was rated more favourably with 100% of delegates reporting that it was a valuable exercise and well designed for local flaps. Conclusions It is imperative that training opportunities are high quality and useful to clinical practice. Techniques learnt in the context of a course or workshop are more valuable where targeted practice may occur following learning. The use of a synthetic pad is more amenable to continued practice where it may be taken home following a workshop. Feedback from this event suggests a well-designed synthetic pad is more useful than animal tissue in learning local flaps.

Aplicación de 2 etil-cianoacrilato para sutura de heridas faciales

La sutura de heridas faciales siempre ha sido un tema controversial, en especial sobre la estética que deja este tipo de procedimiento, ya que el éxito o el fracaso de este depende de varios factores, dentro de ellos podemos referirnos a: el operador, la técnica o el material que se usa para hacer la síntesis de la herida. Lo anterior anuncia la necesidad de un estudio multidisciplinario, en el que los investigadores evalúen alternativas para suturar las heridas. La investigación que se reporta en este artículo es un diseño de serie de casos, desarrollado con seis pacientes pediátricos con heridas faciales a quienes se les aplicó 2 etil-cianoacrilato una fórmula química de C6H7NO2, que fueron apoyados con antibioticoterapia y analgésico dependiendo el caso; se realizaron una serie de evaluaciones periódicas a los casos (1 día, 3 días, 7 días, 14 días y 30 días). El estudio concluyó que la mayoría de los pacientes tuvo una evolución satisfactoria, todos los casos presentaron dolor según la escala EVA en 2 y 3. Por ende, este estudio aporta que el 2 etil-cianoacrilato es una alternativa para las suturas de heridas pediátricas sin ningún efecto adverso. Palabras clave: 2-etil-cianoacrilato, heridas faciales, pacientes pediátricos, cirugía estética, Cirugía Bucal y Maxilo Facial. Abstract The suture of facial wounds has always been a controversial topic, especially regarding the aesthetics that this type of procedure leaves behind. Since, the success or failure of this depends on several factors, within them we can refer to the operator, the technique, or the material that is used to make the synthesis of the wound. The foregoing, heralds the need for a multidisciplinary study, in which researchers evaluate alternatives to suture wounds. The research reported in this article is a case series design, developed with six pediatric patients with facial wounds to whom 2 ethyl-cyanoacrylate was applied, chemical formula of C6H7NO2, which were supported with antibiotic therapy and analgesic as appropriate; A series of periodic evaluations were carried out on the cases (1 day, 3 days, 7 days, 14 days and 30 days). The study concluded that most patients had a satisfactory evolution, all cases presented pain according to the VAS scale in 2 and 3. Therefore, this study contributes that 2 ethyl-cyanoacrylate is an alternative for wound sutures pediatric without any adverse effect. Keywords: 2-ethyl-cyanoacrylate, facial wounds, pediatric patients, plastic surgery, oral surgery y Maxillo facial.

Trenches, Cadences, and Faces

Nancy Sherman examines the lived experience of World War I British soldiers engaged in trench warfare through David Jones’s epic war poem In Parenthesis and Pat Barker’s Toby’s Room. In Sherman’s telling, In Parenthesis demonstrates how the morale and social connectivity of a unit of soldiers is built through verbal and nonverbal interactions alike. Sherman demonstrates how Jones is able to convey these tendencies through the structure and meter of his poem, in concert with its lines. This is the before; Toby’s Room, the second novel in Pat Barker’s second World War I trilogy, addresses itself to the after. Tens of thousands of British soldiers suffered horrific facial wounds in World War I, often repaired or covered up in ways that made it impossible for the soldiers to display emotions or demonstrate motives. Sherman suggests that “to have a massively disfigured face is, in a sense, to lose a social self.” Hiding the face behind a mask, however palatable to the outside world, will never offer an adequate solution.

Maxillofacial Bony Considerations in Facial Transplantation

Alloplastic facial transplantation has become a new rung on the proverbial reconstructive ladder for severe facial wounds in the past couple of decades. Since the first transfer including bony components in 2006, numerous facial allotransplantations across many countries have been successfully performed, many incorporating multiple bony elements of the face. There are many unique considerations to facial transplantation of bone, however, beyond the considerations of simple soft tissue transfer. Herein, we review the current literature and considerations specific to bony facial transplantation focusing on the pertinent surgical anatomy, preoperative planning needs, intraoperative harvest and inset considerations, and postoperative protocols.

Local and Regional Blocks for Complex Facial Wound Repair

The location, severity, and associated injuries of the head and neck trauma dictate the type and treatment location needed for that particular patient. An in-depth knowledge of local and regional block options is vital to the proper management of facial wounds at the bedside, decreasing need for general anesthesia, anesthesia-related complication, length of hospital stay, and overall hospital costs. This article will discuss local and regional block options for the upper-face, midface, and lower face including dentition; complications of local and regional blocks and how to prevent them; and recent advances in local anesthesia. In addition, conscious sedation as an adjunct to local/regional blocks in children or patients with special needs will be discussed.

Flap Tubing And Waltzing For Complex Facial Reconstruction In The West Indies

Ballistic facial wounds present daunting reconstructive challenges to the most experienced of surgeons. The early Waltzing method of tissue transfer, perfected by Sir Gillies, was superseded by free flaps and facial transplantation as methods for facial reconstruction. In the low resource setting, however, the Waltz may be the only suitable option. This case study describes the use of the Waltz for facial reconstruction at the Port of Spain General Hospital in Trinidad. The subject sustained a gunshot wound to the face resulting in complex midface and mandibular defects. Here, bilateral deltopectoral flaps were used to replace destroyed soft tissue.

A rare case of bilateral buccal lesions reconstructed with bipaddle submental artery island flap and buccal fat pad flap along with review of literature

<p class="abstract">Reconstruction of full-thickness buccal defect involving oral commissure which demanding, it requires restoring competency of commissure besides providing lining for two surfaces simultaneously. Such defects prerequisites a pedicled flap each for mucosal and cutaneous surfaces else a free flap with double-paddle skin is needed. We present a case of a 45-year-old gentleman with bilateral buccal mucosa lesions; left side proliferative squamous cell carcinoma (T4N0M0) infiltrating into the cheek and right-sided large verrucous lesion. Reconstruction of verrucous lesion defect was done with buccal fat pad flap following wide local excision, while the SCC lesion resulting defect was reconstructed with de-epithelized bipaddle submental artery island flap (SAIF). Postoperatively patient had an uneventful recovery. The bipaddled SAIF has emerged as innovative modification of the conventional submental flap for reconstruction of composite oro-facial wounds provides lining for both surfaces, requires a shorter operative time than a free flap and avoids donor site deformity associated with double paddled Pectoralis cutaneous flap. The complexity of bilateral buccal defects and utilization of bipaddled design for reconstruction warrants submission of this case with just two cases reported in the literature. </p>

Case Report: Surgical Treatment of Severe Facial Wounds and Proptosis in a Dog Due to a Traffic Accident

Although facial wounds caused by traffic accidents in dogs are common, the surgical management of severe facial injuries involving the soft tissue, bone, dentition, nose and orbit are challenging. A 2 year-old Korean Jindo dog was diagnosed with severe skin defects of the face and proptosis caused by a vehicular accident. Along the left lateral maxilla, severe injury involving the overlying skin and platysma muscle occurred, to the extent that the middle part of the sphincter colli profundus pars intermedia muscle was exposed. Repair surgeries of the skin defects and globe displacement were performed using a local subdermal plexus rotation flap and a partial transposition of the dorsal rectus muscle combined with small intestinal submucosa (SIS) instead of enucleation as the first attempt. SIS was used to sustain the torn medial region. In this case, the surgery resulted in good cosmetic and functional outcome in the dog, despite the atypical complexities upon presentation.

The kite flap for reconstructing tumour excision wounds in the middle and lower face: a retrospective study

Objective: The aim of this study was to present our experience with a kite flap in reconstruction of facial wounds after malignant tumour excision. Method: From October 2008 to September 2017, patients with facial malignant tumour were treated in the Xinjiang Uygur Autonomous Region Bazhou People's Hospital with kite flaps after complete excision. The survival rate, colour, cicatrix of the flap and patient satisfaction were recorded after surgery. Results: A total of 95 patients were included in the study. During follow-up, from six months to 8 years, all the kite flaps achieved primary closure and survived well, and the colour and texture were similar to the surrounding skin with no obvious scar. Dysfunction, complications and recurrence had not been reported. Conclusion: The kite flap may be a good option in reconstructing facial wounds after malignant tumour excision (diameters 1–5cm). It is a simple surgical method with sufficient blood supply and extensive adaptability. For patients in this study, no obvious scars were formed and the recipient site matched well with the donor site.