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Semin Plast Surg 2025; 39(01): 049-056
DOI: 10.1055/s-0045-1801876
Review Article

Management of Avulsive Soft Tissue Ballistic Facial Injuries

Yang Ding
1   Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
2   Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas
,
Winston R. Owens
1   Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
2   Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas
,
Diego M. Quirarte
1   Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
2   Division of Plastic Surgery, Department of Surgery, Texas Children's Hospital, Houston, Texas
,
Olivia G. Leonovicz
1   Division of Plastic Surgery, Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
,
Kerry P. Latham
3   Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, Maryland
› Author Affiliations Funding None.
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Abstract

Ballistic facial injuries are rare yet challenging cases for plastic surgeons that often comprise of avulsive tissue loss. They require in-depth assessment and staged reconstruction after patient stabilization. Each anatomic region of the face holds specific considerations that should be prioritized during reconstruction. Soft tissue repair techniques of facial gunshot wounds are widely variable and range from primary closure to multistage free flaps. Large, devastating facial defects after ballistic trauma previously posed significant challenges for reconstruction; however, advances in composite tissue transplant and allografts have expanded plastic surgeons' reconstructive arsenals. The goal of this review is to focus on the fundamentals of soft tissue management and reconstruction after ballistic facial injury. Through sound surgical principles, patients may achieve optimal aesthetic and functional outcomes despite experiencing highly morbid facial ballistic injuries.

Keywords

ballistic facial injuries - craniofacial trauma - soft tissue reconstruction - composite transplantation

Note

USU-WRNMMC Surgery: The opinions or assertions contained herein are the private ones of the author/speaker and are not to be construed as official or reflecting the views of the Department of Defense, the Uniformed Services University of the Health Sciences or any other agency of the U.S. Government.




Publication History

Article published online:
26 March 2025

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