08 beauty is not skin deep
TRANSCRIPT
Soft tissue injuries & Soft tissue injuries & Composite defects of the Composite defects of the
faceface
Mamoon Rashid SE FCPS (Pak), FRCS (Eng)
Professor of Plastic SurgeryShifa College of Medicine
Consultant Plastic SurgeonShifa InternationalHospital Islamabad
An Advanced Dressing Station in France 1918 Henry Tonks
Modern Plastic Surgery:A specialty forged in the fire of battle
Part-ISoft Tissue Injuries Of The Face
Facial injuries Should alert the examiner to the possibility of
Airway compromise Cervical spine injuries Central nervous system
injuries.
Use of the AMPLE acronym facilitates acomplete trauma history. AAllergiesllergies MMedicationsedications PPast historyast history LLast mealast meal EEvents (surrounding the accident)vents (surrounding the accident)
Evaluation Thorough H&N examination starting pointThorough H&N examination starting point Do not be distracted by more impressive injuriesDo not be distracted by more impressive injuries Carefully assess the face for neurologic deficitsCarefully assess the face for neurologic deficits A complete ocular examinationA complete ocular examination Examination of the oral cavityExamination of the oral cavity Assess for facial bone fracturesAssess for facial bone fractures Records…. Photographs, sketchesRecords…. Photographs, sketches
Imaging
Facial trauma series is a useful screening tool Plain radiographs (anteroposterior [AP], lateral, Caldwell, and Water views).
Also useful for foreign bodies, glass Plain radiographs inadequate to assess severity and
displacement of fractures. In most patients with significant facial impact, CT is
essential ( Preferably with 3-D reconstruction)
Initial care & assessment
Clear airway Control hemorrhage Treat shock Evaluate associated injuries
Types of Soft tissue injuries
Contusion with or without haematoma Abrasion + - Accidental tattoos Retained foreign bodies Puncture Laceration Avulsion Injuries Crush injuries Soft tissue and Composite tissue loss
Preparation for treatment of soft tissue injuries
Good light Anesthesia Proper instruments and
sutures Shaving the area….
Never the eyebrow Consent and Counseling
Simple Lacerations:Technique of repair
Anaesthesia local or general Irrigation and Debridement Conservative Debridement of
ragged / tangential/ contused edges Secure haemostasis Repair in layers
Wind shield injuries
Avulsion flaps
Injury to Parotid Duct
Medial eye and Lacrimal apparatus
Eyelid injuries
Medial canthal Ligament Disruptions
Injury to Facial Nerve Branches
Part- IIComplex facial injury with composite loss of tissue
Composite Osteocutaneous defects
Management Protocol
Clinical Assessment General Defect
Investigations OPG 3D – CT Recon
Recreation of primary defect
Doppler USG (Fibula)
Template-based flap designing
Reconstruction Bone fixation Flap Inset
Follow-up
Lower face and Jaw defects
RE
Combined mid-face and Combined mid-face and mandibular defectsmandibular defects
The key to a successful reconstruction of composite facial injuries lies in;
Adequate defect assessment (including re-creation of original
defect) Meticulous flap planning A lot of imagination.
Osteo-cutaneous flaps should be considered as first choice for these complex situations.
Achieving a “normal” appearance remains elusive
Lessons Lessons LearntLearnt
Humbling Humbling ExperienceExperience
“If it is not normal it is not enough".
Dr. Paul Tessier (1917-2008)(1917-2008)
Thank you"Beauty, as defined by society at large, seemed to be only about who was best at looking like everyone else." — Lucy Grealy (Autobiography of a Face)