Contemporary Management of Facial Soft Tissue Trauma

Ryan N. Heffelfinger, M.D. Edmund A. Pribitkin, M.D., F.A.C.S.

Although modern facial plastic surgery was born in the field hospitals of World War I, the treatment of facial soft tissue trauma ironically receives short shrift in many contemporary textbooks of facial plastic surgery. Nonetheless, our modern aesthetic and reconstructive surgical armamentarium was first forged in the crucible of war through the efforts of battlefield surgeons such as Sir Harold Gillies to reconstruct facial features torn apart by sophisticated new military weapons. The widespread use of anesthesia and antisepsis, the development of the light bulb and sterile cat gut suture, and the unprecedented interaction of surgeons from many different specialties enabled advances in reconstructive techniques during and immediately after World War I.

Like his predecessors, today's facial trauma surgeon adapts evolving technologies to offset the damage inflicted by the harsh realities of modern times, where speed may supersede safety and where new means of interaction and conveyance do not adequately account for the vagaries of human temperament. In this issue, Timothy J. McDonald and Manuel A. Lopez explore the lessons of a new war marked by a resurgent use of improvised explosive devices and a continuing lack of facial protective armor. Samuel M. Lam and P. Daniel Knott et al delineate new avenues of facial soft tissue reconstruction through fat grafting and microvascular free flap techniques, respectively. Our many distinguished authors share their experiences and insights in the repair of facial soft tissue injuries. None of our work would be possible, however, without the dedicated efforts of our first responders. Accordingly, we dedicate this issue to the first medically trained personnel to arrive on the scene—to the emergency medical technicians, police officers, military rescue teams, firefighters, and good Samaritans who rescue our patients and bring them to our care.