A new prospect on the approach to open, complex, craniofacial trauma.
Complex craniofacial trauma has been traditionally managed in three stages: urgent craniotomy, secondary orbitofacial repair and delayed cranioplasty. Departing from this conventional approach, we employ an early single-stage neuro and plastic-surgical reconstruction for patients presenting open cranial wounds of the frontobasilar region coexisting with orbitofacial fractures. Neurological outcome does not seem to be affected by the additional operating time, nor is the incidence of infection raised, although bone fragments are repositioned, primary bone grafting is employed, and metallic material is used for fixation. Adequate direct exposure followed by reduction and rigid internal fixation results in primary bone healing and permits to avoid the difficult complications related to soft tissue contracture over misaligned bone. Compared with the conventional staged approach, immediate reconstruction appears functionally and aesthetically preferable, as well as technically easier.
Robotti
E
E
Department of Plastic Surgery, Brown University, Providence, Rhode Island.
Forcht Dagi
T
T
Ravegnani
M
M
Bocchiotti
G
G
D000063:Accidents, Traffic; D000328:Adult; D000758:Anesthesia / Q000379:methods; D016025:Bone Transplantation; D001930:Brain Injuries / Q000601:surgery; D004388:Dura Mater / Q000293:injuries* / Q000601:surgery; D005147:Facial Bones / Q000293:injuries* / Q000601:surgery; D005151:Facial Injuries / Q000601:surgery*; D005592:Fracture Fixation / Q000379:methods*; D005597:Fractures, Open / Q000150:complications / Q000601:surgery*; D006801:Humans; D007572:Jaw Fractures / Q000601:surgery; D008297:Male; D009104:Multiple Trauma / Q000601:surgery*; D009917:Orbital Fractures / Q000601:surgery; D010256:Paranasal Sinuses / Q000293:injuries / Q000601:surgery; D012887:Skull Fractures / Q000601:surgery*; D013518:Surgery, Plastic / Q000379:methods*; D013524:Surgical Flaps; D013530:Surgical Wound Infection / Q000453:epidemiology / Q000517:prevention & control; D016896:Treatment Outcome