Gunshot wounds to the head and neck.
OBJECTIVE
Gunshot wounds to the head and neck result in significant bone and soft tissue loss. These defects pose a challenge to the facial reconstructive surgeon. This paper reviews the current literature on the management of ballistic injuries to the head and neck and outlines a treatment algorithm.


RESULTS
With recent advances in free tissue transfer, early definitive reconstruction of bone and soft tissue deficits with vascularized flaps has become the treatment of choice. Computed tomography angiography of the neck has been shown to be a sensitive, specific, and safe technique in screening for vascular injuries.


CONCLUSIONS
Management of ballistic injuries to the head and neck begins with advanced trauma life support protocols. Computed tomography angiography is now widely available and provides an accurate and rapid evaluation of head and neck vasculature. The initial operation aims to establish occlusion, stabilize bone and close soft tissue defects. Serial debridement of wounds with delayed reconstruction has given way to early definitive repair with vascularized tissue. This has led to improved function, fewer operations, and shorter hospital stays.
Doctor
Vishal S
VS
Department of Otolaryngology-Head and Neck Surgery, UC Davis Medical Center, Sacramento, California, USA.
Farwell
D Gregory
DG
D044964:Cervicoplasty / Q000379:methods*; D006259:Craniocerebral Trauma / Q000601:surgery*; D006801:Humans; D019838:Neck Injuries / Q000601:surgery*; D019651:Plastic Surgery Procedures / Q000379:methods*; D014948:Wounds, Gunshot / Q000601:surgery*