AAPS, American Association of Plastic Surgeons
AAPS, American Association of Plastic Surgeons
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2008 Annual Meeting Abstracts

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Gunshot Wounds to the Face: A Ten Year County Hospital Experience
John Brian Boyd, MD, Clifford Pereira, MD, Brian Dickinson, MD, Brant Putnam, MD.
Harbor-UCLA, Torrance, CA, USA.

PURPOSE:
Gunshot wounds (GSWs) to the face are an infrequent occurrence outside of a war zone, yet a constant feature of inner city crime and gang violence. Patients surviving the initial injury constitute a significant reconstructive challenge. The surgical literature is scant regarding the natural history, evaluation and treatment of such injuries. We present our ten year experience at an urban level I trauma center.
METHODS:
A retrospective review was performed on all patients admitted to Harbor UCLA with GSWs to the head and neck region between January 1997 and January 2007. Patients who had sustained GSWs to the face and underwent operative intervention were selected for this study.
RESULTS:
Between 1997 and 2007, a total of 702 patients were admitted to the Harbor UCLA ER having sustained GSWs to the head and neck region, of which 501 patients survived. Of 379 neck injuries, 23 died; of 260 head injuries, 159 died; and of 63 facial injuries 19 died. Twenty-eight patients (26 males, 2 females) sustained GSWs to their face requiring operative intervention. The mean age of these patients was 28 (±8.3) years, with presentations being within a few hours of the injury and delayed presentation (>1day) in only one case. Low velocity single missiles were predominantly involved, with facial fractures occurring in all cases. Mean length of hospital stay was 8.3 (±7.1) days, with 50% cases requiring ICU stay. Mean length of ICU stay was 5.2 (±5.7) days. Tracheostomy was required in 35.7% cases. The soft tissue injuries were handled according to the reconstructive ladder, and the bone fractures by standard craniofacial techniques. Free tissue transfer for reconstruction was required in 14.2 cases (three fibular free flaps, one TRAM). All 28 survived.
CONCLUSION:
1. In the civilian Los Angeles urban population, GSWs to the face are usually caused by single low velocity missiles in young mature males. Most require wound debridement and fracture fixation with free tissue transfer in about 14%.
2. The fatality rate of patients brought to Harbor-UCLA with GSW to the face was 30% compared with 61% in GSW to the head and 6.5% in GSW to the neck.
3. Over a third of patients with GSW to the face required tracheotomy.
4. Those patients with GSW to the face who underwent surgery survived and returned to society within two weeks.
5. Free tissue transfer is an important reconstructive tool in a small proportion of cases.


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