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Esthetic Reconstruction of Complex Facial Soft Tissue Trauma

All soft tissue injuries were treated with primary intention following debridement, irrigation, and primary surgical intervention by different methods depending on the defect size and location. They explained probable complications of primary intention to all patients and informed consents were obtained from all patients before surgical interventions. The medical ethics committee of their hospital approved the study protocol. They used primary closure, skin graft, and different local flap techniques to fit the location of the injury and compensate for the extent of tissue loss. After 48 h, dressings were removed and all patients received prophylactic oral antibiotics for 24-48 h (a dose before surgery and 48 h after surgery). They had complex soft tissue damage in some of the cases (Figure 1). Early post-operative pulsed dye laser (PDL) was used two weeks post operation in three sessions. The aim of PDL therapy was better esthetic results in all facial suture lines, except in periorbital and ear regions.

Figure 1. Click to unblur
A 30-Year-Old Woman With Severe Forehead Soft Tissue Defect Due to Blunt Trauma. A) Before operation, B) early post operation, C) one month post operation, D) one year post operation.

Forehead

For the repair of soft tissue injuries of the forehead, conservative debridement and washing should be performed in the early stages and the line of repair should be parallel to Langers lines (Figure 1). For the repair, adjacent soft tissue is in priority and should be released and used for esthetic reconstruction. The earlier these injuries are repaired, the better will be the cosmetic results. In some cases with tissue defects, local flap or skin graft was necessary for reconstruction (Figure 2).

Figure 2. Click to unblur
A 10 Year-Old Girl With Severe Complex Forehead, Eyebrow, Eyelid, Nose and Frontal Branch of Facial Nerve Damage After Car Accident. A) Before operation, B) intra operative view, C) early post operation, D&E) one year post operation.
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