Contemporary issues in facial gunshot wound management

Facial gunshot wounds pose a significant challenge for reconstructive surgeons, particularly when composed of significant soft and bone tissue defects. Often the result of assault, accident, or suicide attempt, facial defects must be thoroughly evaluated to devise an appropriate tissue repair and replacement with the likely prospect of secondary revision. In the acute setting after injury, the primary concern is patient stabilization centered on advanced trauma life support. Thorough examination along with appropriate imaging is critical for identifying any existing defects. As opposed to past surgical management that advocated delayed definitive treatment using serial debridement, today's management favors the use of more immediate reconstruction. Recent improvements in microsurgical technique have shifted favor from local tissue advancement to distant free-flap transfers, which improve cosmesis and function. This has reduced the number of surgeries necessary to achieve reconstruction. Given the diversity and complexity of facial gunshot injuries, a systematic algorithm is essential to help manage the different stages of healing and to ensure that the best outcome is ultimately achieved.