Zeidan Toufic, Kassouf Elia, Ahmadieh Nizar, Nassar Aref, Jabbour Georges, Sleilati Fadi
From the Faculty of Medicine, Saint Joseph University, Beirut, Lebanon.
Plast Reconstr Surg Glob Open. 2024 Aug 13;12(8):e6066. doi: 10.1097/GOX.0000000000006066. eCollection 2024 Aug.
Ballistic trauma to the face is a challenge, combining complex bone injury with severe soft tissue loss. The various surgical methods available are influenced by the extent of injuries. This study compares different operative modalities and their outcomes with different variables, aiming to define the ideal therapeutic approach.
We retrospectively compared reconstructive modalities used to treat facial ballistic trauma cases at Hôtel-Dieu de France Hospital, Beirut, Lebanon, for a 12-year span. Statistical analysis was used to determine correlation between several factors and satisfactory results.
Eighteen patients were included, with varying degrees of bone and soft tissue loss. After conservative debridement, fractures were treated by different modalities: open reduction and internal fixation, maxillomandibular fixation, and osteosynthesis with a reconstruction plate. Although primary closure was sufficient in 10 cases, severe loss of tissues was reconstructed with a fibular free flap in five cases, radial free forearm flap in two cases, and free parascapular flap in one case. Two others received an iliac bone graft as secondary reconstruction. The average follow-up was 2.45 years. Most cases achieved good aesthetic and functional results after several secondary operations, with few late complications. Early reconstruction and younger patients were associated with better outcomes.
We favor early debridement and reconstruction. Free flaps were ideal for extensive tissue loss. Bone grafting was needed secondarily. A single surgical procedure seldom led to satisfactory functional and aesthetic outcomes, and secondary operations were inevitable.
面部弹道伤是一项挑战，它将复杂的骨损伤与严重的软组织缺损结合在一起。现有的各种手术方法受到损伤程度的影响。本研究比较了不同的手术方式及其在不同变量下的结果，旨在确定理想的治疗方法。
我们回顾性比较了黎巴嫩贝鲁特法国主宫医院在12年期间用于治疗面部弹道伤病例的重建方式。采用统计分析来确定几个因素与满意结果之间的相关性。
纳入18例患者，他们有不同程度的骨和软组织缺损。在进行保守清创后，骨折采用不同方式治疗：切开复位内固定、颌间固定以及用重建钢板进行骨合成。虽然10例患者一期缝合就足够了，但5例严重组织缺损患者采用游离腓骨瓣重建，2例采用游离桡侧前臂瓣重建，1例采用游离肩胛旁瓣重建。另外2例接受髂骨移植作为二期重建。平均随访2.45年。多数病例经过几次二期手术后获得了良好的美学和功能效果，晚期并发症很少。早期重建和较年轻的患者预后较好。
我们支持早期清创和重建。游离皮瓣对于广泛的组织缺损是理想的选择。二期需要进行骨移植。单一手术很少能带来满意的功能和美学效果，二期手术不可避免。
