Comparing Early and Late Reconstruction of Gunshot Injuries to the Upper and Lower Face

Gunshot injuries represent one of the most challenging injury patterns to the head and neck region because they are  often complex depending on the velocity and caliber of the bullet and the type of firearm. Some surgeons prefer early reconstruction including open reduction and internal fixation of osseous deformities while others advocate delayed reconstruction.

The purpose of this study examined the postoperative morbidity and mortality associated with early and late reconstruction of the upper and lower face associated with gunshot injuries.

We conducted a chart review of 42 cases (33 male, 9 female) of gunshot injuries to the mandible and/or mid-face who required operative intervention from 2007-2013 at Parkland Memorial Hospital in Dallas Texas. Patients were stratified into two groups depending on timing of reconstruction. Reconstruction was defined as closed or open reduction in an operating room enviorment with or without debridement. The following treatments were included: 34/42 with open reduction internal fixation, 2/42 with external fixation, and 6/42 cases in closed fashion with application of arch bars.

 The primary outcome, minor and severe adverse events in the post operative course were compared by dividing the patients into two groups. Group 1 including patients who underwent reconstruction within first week from injury (early reconstruction or group ER). Group 2 including patients who underwent reconstruction after the first week from injury (late reconstruction or group LR). There was a total of 24 subjects in group ER and 18 subjects in group LR. The primary outcome was further stratified by the event in the post-operative courses. Normal or no adverse events ( NAE) including those patients who had no adverse events during the postoperative period and patients who required additional surgical intervention due to minor or major adverse events (MAE). Minor adverse events were defined as wound dehiscence or infection requiring local debridement or washout, in contrast to major adverse events which were defined as wound infection requiring removal of hardware and/or failure of bone graft. There were 22 subjects in group NAE, and 20 subjects in group MAE. Of the 24 subjects within group ER- 13 were in NAE, 11 in MAE. Of the 18 subjects within group LR- 9 were in NE, 9 in MAE.

We conclude that both early and late reconstruction of gunshot injuries had similar post-operative course in the occurances of postoperative presence or absence of minor and major adverse events.

Reference 

1)Kaufman Y, Cole P, et al : Facial Gunshot wounds : Trends in Management. Craniomaxillofac Trauma Reconstr 2:85,2009.

2)Shackford SR, Kahl JE et al : Gunshot and blast injuries to the face are associated with significant morbidity and mortality: result of an 11-year  multi-institutional study of 720 patients. J Trauma Acute Care Surg. 76: 347,2014.