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Face Avulsion and Degloving

A 25 years old female presented with alleged history of assault by husband over the left hemi-face by a sickle two days after the trauma. There was degloving and avulsion of the left upper hemiface including the nose, forehead skin and eyebrow on the left side, upper and lower eyelids and part of the cheek. The globe as well as eyesight was intact. The extra ocular movements were present (Figure 1).

Fig. 1: Hemifacial degloving in the patient.

A detailed evaluation under anesthesia revealed that there was loss of the anterior cortex of the frontal sinus, and loss of the nasal bones as well. The part of the frontal sinus was attached to the degloved skin flap. Part of frontal bone on left side was exposed. The wound was contaminated with small amount of mud particles.

A forehead flap was raised based on the right supraorbital and supratrochlear vessels and transposed medially to cover the exposed frontal sinus and exposed frontal bone.

A proximally based nasolabial flap was used to cover the skin defect on the dorsum and right lateral wall of the nose. A small defect on the cheek region was split skin grafted. The post operative course was uneventful (Figure 2 and 3).

Fig. 2: Intra-operative picture showing canthopexy,
harvested nasolabial flap and forehead flap.
Fig. 3: Well settled flaps and position of medial and
lateral canthi.

After four weeks, costal cartilage graft was used for nasal augmentation. Costal cartilage was placed in an L shaped manner for
augmentation of the columella and dorsum of the nose.

One year after the trauma, and after two surgeries, we had a satisfied patient with no functional deficit (Figure 4).

Fig. 4: After nasal dorsum augmentation and
debulking of nasolabial flap.

There were no nasal or ocular complaints. Eye opening and closure
were normal.

Credit: Panse N, Sahasrabudhe P, Joshi N. WJPS