title: High-velocity facial gunshot wounds: multidisciplinary care from prehospital to discharge.
abstract: A case is presented in which a high velocity rifle (shotgun) was fired into the inferior part of a patient's face in an attempted suicide causing widespread trauma to the inferior and left side of the patient's face. He presented to his general practitioner where an ambulance was called. The patient is followed from prehospital care (air ambulance) to resuscitation in accident and emergency and through the first stages of reconstructive surgery. The article focuses on the multidisciplinary approach to the patient's prehospital care and initial resuscitation at a major trauma centre. CT reconstruction images of the patient's skull allow visualisation of the extent of bone damage at presentation. Medical photography allows visualisation of the extent of the initial damage and shows how reconstructive surgery was undertaken early and in progressive stages. A literature review was performed allowing discussion of the current evidence and best practice in the management of facial gunshot wounds.
authors.affiliation: East Sussex Healthcare Trust, Eastbourne, UK.
authors.forename: J D
authors.initials: JD
authors.lastname: Sinnott
authors.affiliation: St Mary's Hospital, London, UK.
authors.forename: G
authors.initials: G
authors.lastname: Morris
authors.affiliation: East Sussex Healthcare Trust, Eastbourne, UK.
authors.forename: P J
authors.initials: PJ
authors.lastname: Medland
authors.affiliation: University Hospital Birmingham, Birmingham, UK.
authors.forename: K
authors.initials: K
authors.lastname: Porter
mesh_terms: D005151:Facial Injuries / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D019651:Plastic Surgery Procedures / Q000379:methods; D012151:Resuscitation / Q000379:methods; D017695:Soft Tissue Injuries / Q000601:surgery*; D013406:Suicide, Attempted; D014948:Wounds, Gunshot / Q000601:surgery*
references.citation: J Oral Maxillofac Surg. 2001 Mar;59(3):277-82
references.pmid: 11243609
references.citation: Craniomaxillofac Trauma Reconstr. 2009 May;2(2):85-90
references.pmid: 22110801
references.citation: Facial Plast Surg. 2005 Aug;21(3):191-8
references.pmid: 16307399
references.citation: J Trauma Acute Care Surg. 2014 Feb;76(2):347-52
references.pmid: 24398775
references.citation: Otolaryngol Head Neck Surg. 1996 Nov;115(5):464-70
references.pmid: 8903449
references.citation: World J Surg. 2007 Nov;31(11):2104-10
references.pmid: 17828571
references.citation: Am J Otol. 1999 Jan;20(1):96-114
references.pmid: 9918183
references.citation: J Trauma. 1998 Jul;45(1):39-41
references.pmid: 9680009
references.citation: J Trauma. 1993 Oct;35(4):569-75; discussion 575-7
references.pmid: 8411281
references.citation: Int J Oral Surg. 1974;3(1):29-33
references.pmid: 4211244
references.citation: J Emerg Trauma Shock. 2011 Apr;4(2):212-6
references.pmid: 21769208