Use of bilateral folded radial forearm free flaps for reconstruction of a midface gunshot wound. 1998

F J Duffy, and B S Gan, and D Israeli, and M B Tantillo, and M J Yaremchuk
Division of Plastic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, USA.

Optimal treatment of midfacial gunshot wounds includes early definitive reconstruction of the bony scaffold to prevent soft tissue contraction. When this is not possible, secondary reconstruction is more difficult. The authors present a case of delayed reconstruction of a midface gunshot wound. Two months following a self-inflicted, submental gunshot wound and eventual rigid fixation of the remaining midfacial bony anatomy, two simultaneous radial forearm free flaps were utilized in the reconstruction. The first flap was folded onto itself to recreate the hard palate in conjunction with a split rib graft; the second flap filled the remaining soft-tissue defect and simultaneously provided lining for an eventual staged nasal reconstruction. The second stage of the nasal reconstruction was completed 5 weeks later with a calvarial bone graft and forehead flap. This dual microsurgical approach allowed for one-step reconstruction of both surfaces of the hard palate, resulting in separate oral and nasal cavities, and optimizing the patient's ability to speak and eat. Extensive soft-tissue contraction encountered in late reconstructions underscores the importance of an early, definitive, surgical approach in these difficult wounds.

UI MeSH Term Description Entries
D008297 Male Males
D008437 Maxilla One of a pair of irregularly shaped bones that form the upper jaw. A maxillary bone provides tooth sockets for the superior teeth, forms part of the ORBIT, and contains the MAXILLARY SINUS. Maxillae,Maxillary Bone,Bone, Maxillary,Bones, Maxillary,Maxillary Bones,Maxillas
D010159 Palate The structure that forms the roof of the mouth. It consists of the anterior hard palate (PALATE, HARD) and the posterior soft palate (PALATE, SOFT). Incisive Papilla,Incisive Papillas,Palates,Papilla, Incisive,Papillas, Incisive
D005151 Facial Injuries General or unspecified injuries to the soft tissue or bony portions of the face. Injuries, Facial,Facial Injury,Injury, Facial
D005542 Forearm Part of the upper extremity in humans and primates extending from the ELBOW to the WRIST. Antebrachium,Antebrachiums,Forearms
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000293 Adolescent A person 13 to 18 years of age. Adolescence,Youth,Adolescents,Adolescents, Female,Adolescents, Male,Teenagers,Teens,Adolescent, Female,Adolescent, Male,Female Adolescent,Female Adolescents,Male Adolescent,Male Adolescents,Teen,Teenager,Youths
D012886 Skull The SKELETON of the HEAD including the FACIAL BONES and the bones enclosing the BRAIN. Calvaria,Cranium,Calvarium,Skulls
D013524 Surgical Flaps Tongues of skin and subcutaneous tissue, sometimes including muscle, cut away from the underlying parts but often still attached at one end. They retain their own microvasculature which is also transferred to the new site. They are often used in plastic surgery for filling a defect in a neighboring region. Island Flap,Island Flaps,Flap, Surgical,Flaps, Surgical,Pedicled Flap,Surgical Flap,Flap, Island,Flap, Pedicled,Flaps, Island,Flaps, Pedicled,Pedicled Flaps
D014948 Wounds, Gunshot Disruption of structural continuity of the body as a result of the discharge of firearms. Gunshot Wound,Gunshot Wounds,Wound, Gunshot

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