title: Definitive management of severe facial trauma utilizing free tissue transfer.
abstract: OBJECTIVE
  Severe ballistic or avulsion injuries to the face create complex, composite defects. We report the results of an aggressive management algorithm to optimize facial form and function: (1) the initial encounter, (2) definitive reconstruction with vascularized tissue, and (3) aesthetic and prosthetic refinement.
  
  
  METHODS
  Retrospective case series of 49 patients in 2 tertiary care institutions. Patients were evaluated for age, gender, mechanism of injury, anatomic subsites involved, surgical procedures, flaps utilized, complications, and functional outcomes.
  
  
  RESULTS
  Forty defects were gunshot wounds, 9 resulted from major avulsive trauma. Involved sites included 13 oromandibular, 21 midface/upper face, and 15 combined sites; 54 free flaps were utilized, 21 were soft tissue and 33 contained bone. No flap failures occurred. Function and cosmesis were best in the oromandibular only group, and worst in the combined group with nasal and/or orbital tissue loss.
  
  
  CONCLUSIONS
  Treatment of severe facial trauma requires early tissue debridement with bony repair and/or stenting to minimize scar contracture. Free tissue transfer techniques allow simultaneous reconstruction of the bony framework and overlying tissues. Multiple secondary procedures are frequently required for optimal aesthetic restoration.
  
  
  METHODS
  C.
authors.affiliation: University of Washington School of Medicine, Department of Otolaryngology-Head and Neck Surgery, Seattle 98195-6515, USA. nfutran@u.washington.edu
authors.forename: Neal D
authors.initials: ND
authors.lastname: Futran
authors.forename: D Gregory
authors.initials: DG
authors.lastname: Farwell
authors.forename: Russell B
authors.initials: RB
authors.lastname: Smith
authors.forename: Paul E
authors.initials: PE
authors.lastname: Johnson
authors.forename: Gerry F
authors.initials: GF
authors.lastname: Funk
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000465:Algorithms; D002985:Clinical Protocols; D005151:Facial Injuries / Q000601:surgery*; D005260:Female; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods*; D012189:Retrospective Studies; D013524:Surgical Flaps; D016378:Tissue Transplantation