Department of Surgery, Uniformed Services University of Health Sciences, Bethesda, Maryland.
Department of Otolaryngology, University of Texas San Antonio, San Antonio, Texas.
Facial Plast Surg. 2021 Aug;37(4):432-438. doi: 10.1055/s-0041-1725130. Epub 2021 Feb 25.
Projectile injuries to the face deserve particular attention to evaluate for involvement of critical structures and functional elements and treat the devastating effects on facial aesthetics. Ballistic trauma to the maxillofacial region often has significant soft tissue and bony defects, creating a greater challenge to the reconstructive surgeon. The main goals of treatment of projectile injuries to the face are decreasing the amount of contaminants and nonviable tissue at the site, ensuring functionality, and restoring aesthetic appearance. There exists a lack of robust research on the subject. Soft tissue injuries from high-velocity projectiles have changed the perspective on treating acute injuries to the face and neck. Injuries encountered during both Operation Iraqi Freedom and Operation Enduring Freedom give the author pause to reflect upon a different wounding pattern than that encountered in stateside trauma centers. Given the dissemination of high-velocity weaponry by enemy combatants such as the improvised explosive device, mortar round, and high-velocity rifles, a higher incidence of facial wounds has been reported. The mechanism of injury and a stepwise approach for surgical repair are discussed incorporating advanced trauma life support principles and a reconstructive ladder of repair.
面部投射物伤需要特别注意，以评估是否涉及关键结构和功能要素，并治疗对面部美学的毁灭性影响。颌面弹道创伤常伴有显著的软组织和骨缺损，这对重建外科医生提出了更大的挑战。面部投射物伤治疗的主要目标是减少损伤部位的污染物和失活组织的数量，确保功能，并恢复美观。目前该领域缺乏强有力的研究。来自高速投射物的软组织损伤改变了人们对面部和颈部急性损伤治疗的看法。在伊拉克自由行动和持久自由行动中遇到的损伤，使作者反思在国内创伤中心遇到的不同创伤模式。由于敌方战斗人员如简易爆炸装置、迫击炮弹和高速步枪传播高速武器，面部伤口的发生率有所增加。讨论了损伤机制和手术修复的分步方法，结合了先进的创伤生命支持原则和修复重建阶梯。
