Facial reconstruction following blast injury.

The facial plastic surgeon, when treating a patient with massive loss of soft tissue and bone of the face secondary to blast injury, must carefully consider available treatment options. The choice of procedure should be dictated by the likelihood of success, donor site morbidity, and the potential for complications. Five illustrative cases of blast injury to the lower face are presented to demonstrate methods of reconstruction currently available. Local soft-tissue flaps appear to be superior to regional or distant flaps for the restoration of form and function of the lower lip. Autogenous, particulate cancellous bone is a satisfactory grafting material for the great majority of traumatic mandibular defects. Vascularized bone grafts should be considered when extensive defects of the anterior arch exist or when a sterile, supple, well-vascularized recipient bed is not available.