Abstract
Background Acute facial trauma in motor vehicle accident defects may be associated with skeletal,
neuromuscular, or mucosal losses. Simultaneous repair of the critical structures in
these defects mandates the use of flap cover; paucity of local tissues necessitates
the use of free skin flaps.
Materials and Methods Six free flap reconstructions for acute facial trauma defects over a 10-year period
were reviewed. The defect location, associated injuries, flap choice, additional reconstructive
procedures, and flap outcomes were analyzed.
Results There were four males and two females with ages between 18 and 63 years. Four defects
were located in the lateral face and scalp, and two in the lower central face. Defect
size ranged between 96 and 346 cm2. There were fractures in three, facial nerve injuries in two, and loss of facial
muscles in one. Five free flaps were anterolateral thigh flap; simple and composite,
one was a radial artery forearm flap. Recipient pedicles were the superficial temporal
vessels in two and facial vessels in four cases. There were no re-explorations but
one flap necrosed on 7th postoperative day on account of invasive aspergillosis.
Discussion Use of free flaps for ballistic wounds is common. In uncommon nonballistic traumatic
facial defects, the location, nature of the defect, and type of associated injuries
and need for simultaneous reconstructions may dictate the use of free flaps and permit
a one stage debridement, flap coverage, and a simultaneous reconstruction of lost
functional units.
Conclusion Free flap coverage in high velocity acute facial trauma defects offers a better possibility
for primary reconstruction of associated facial injuries and helps in achieving better
functional outcomes.
Keywords
acute facial trauma defects - free flaps in facial trauma - primary reconstruction
