Gunshot wounds to the face

Abstract

The surgical treatment of gunshot wounds of the maxillofacial region, frequently observed in military areas, still presents conflicting evidence to the surgeons. The main goal in such injuries, besides maintaining vital signs, is to ensure primary healing of soft tissue. If this is realized, the complications will be minimized. The secondary goal is to achieve the best possible aesthetic and functional result. This can be realized only in cases involving bone as well as soft tissue reconstruction. Bone reconstruction in the first 48 hours will prevent soft tissue from collapsing and contracture. We have treated 52 patients with facial gunshot wounds in the period between 1986 and 1992. Twenty-two of these were treated immediately by reconstruction of bone and soft tissue, while emphasizing drainage due to high risk of infection. In 30 patients, we allowed wounds to heal secondarily because of accompanying other severe injuries or medical problems, and performed the reconstruction later. The two patient groups were followed for a period of 6 months, at the end of which a comparison was made of the complications, functional and aesthetic results. It has been concluded that immediate surgical treatment is ideal in facial gunshot wounds excepting special circumstances.