Small-vessel pathology and anastomosis following maxillofacial firearm wounds: An experimental study

doi:10.1016/0278-2391(91)90368-V

Journal of Oral and Maxillofacial Surgery

Volume 49, Issue 4, April 1991, Pages 348-352

https://doi.org/10.1016/0278-2391(91)90368-V Get rights and content

Abstract

This experiment was designed to provide a biological basis for early reconstruction of maxillofacial defects caused by firearms using free vascularized flap transfer. The pathologic changes of small-vessel injury, injury mechanism, and the feasibility for early anastomosis of these vessels in the maxillofacial region following high-velocity missile wounds were studied. Dogs' faces were wounded by a steel sphere, weighing 0.7 g and 1.03 g, with an initial velocity of 1,300 m/s or 1,500 m/s. Angiography and highspeed x-ray photography were used to record the effect of injury to blood vessels and other tissues. The pathologic changes in the small blood vessels in the wounds were studied by light microscopy (LM) and electron microscopy (EM). Anastomosis of small vessels in the wound was performed at different times after injury. There were temporary cavity effects and small vascular injury in the wounds. The pathologic changes of the small vessels included microthrombus formation, endothelial loss, breaks in the internal elastic layer, and necrosis. Degeneration of cells was found to end 3 cm from the wound edge. Anastomosis of the vessels performed 3 days after injury provided good short-term patency. These results suggest that the operation for repairing facial defects should be performed 3 days after injury.

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Ballistic injury patterns to the craniomaxillofacial region present a unique, and challenging, dilemma for the facial trauma surgeon. The tissue disruption associated with ballistic injury to the head and neck region can be daunting, and the identification of normal anatomic planes, potentially lost within bleeding, destroyed soft and hard tissues, can challenge the skills of even the most experienced facial trauma specialist. While classically considered to be under the purview of the military trauma surgeon, ballistic and blast injuries are routinely treated by the civilian surgeon due to the incidence of intentional and unintentional firearm injuries and industrial accidents. Unfortunately, as evidenced by the recent surge of terrorist attacks in locales such as Paris, France and Orlando, Florida, the civilian craniomaxillofacial trauma surgeon must have not only a working knowledge of the management of ballistic wounds to the craniofacial region, but also an understanding of the staging and timing of the treatment of these injuries. A basic understanding of the definitions and characteristic clinical findings of ballistic and blast wounds should be an important tool in the armamentarium of the practicing craniomaxillofacial trauma surgeon.
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Citation Excerpt :
High-energy transfer may result in temporary damage to the microcirculation of the soft tissue at a distance from the permanent wound, which must be considered when planning microvascular anastomoses. This is based on an experimental study conducted by Tan et al20 who fired projectiles that simulated fragments into the faces of dogs. They found thromboses in the facial vessels up to 3 cm from the macroscopic wound edges, which they attributed to the effect of the temporary cavities.
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Management of Military Ballistic Injuries to the Face and Neck
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Clinical articleSmall-vessel pathology and anastomosis following maxillofacial firearm wounds: An experimental study

Abstract

Br J Plast Surg

Wound ballistics

Prog Surg

Wound ballistics of gunshot injuries to the head and neck

Arch Otolaryngol

Wound ballistics of soft-tissue injuries to the head and neck

Vascular injuries: An experimental study of high and low velocity missile wounds

Arch Surg

Clinical article
Small-vessel pathology and anastomosis following maxillofacial firearm wounds: An experimental study