From injury to reconstruction, utilizing staged technique in a self-inflicted facial gunshot wound: a case report

Facial gunshot injuries are rare and complex, with mortality and complication rates of up to 15% and 30%, respectively. Management of facial gunshot wounds has proven to be challenging for surgeons because the treatment requires multidisciplinary evaluation and planning. We present a rare case of a gunshot wound to the face that resulted in extensive deformities, requiring multiple reconstructive procedures.

A 19-year-old male of South Asian (Pakistani) origin presented to the emergency department with a 3-day-old gunshot wound to the floor of the mouth, causing extensive defects in the maxilla, mandible, and soft tissue, as well as comminuted fractures of the bilateral maxillary and ethmoid sinuses. Reconstruction involved an osseocutaneous free fibular flap for the mandible, radial forearm flap for the upper lip, and iliac crest bone graft for the maxillary alveolus. Nasal framework reconstruction was achieved by using a costochondral rib graft. A secondary radial forearm free flap, staged as an Abbe flap, was performed a year later. A complex surgical approach was executed, resulting in functional and aesthetic restoration.

This case highlights the intricate nature of managing facial gunshot injuries, which requires a multidisciplinary approach and meticulous planning. Through a series of staged reconstructive procedures, including the use of free flaps and bone grafts, we achieved significant functional and aesthetic restoration. Our experience demonstrates the value of tailored reconstructive techniques in managing complex maxillofacial trauma, offering valuable guidance for surgeons in handling similar cases. By sharing this approach, we aim to contribute to the advancement of surgical care for patients with severe facial trauma, ultimately improving the outcomes, particularly in resource-constrained environments.