Self-inflicted gunshot wounds of the lower half of the face: the evolution toward early reconstruction.

The self-inflicted gunshot wound of the lower half of the face traditionally has been treated by multistaged and prolonged reconstructive maneuvers that often left significant and uncorrectable secondary deformities. Modern cranio-maxillofacial methods for reduction and rigid fixation of the facial skeleton, using immediate autogenous bone grafts when required, also has been efficacious for the acute management of these severe gunshot injuries. These methods can reduce the previously expected morbidity. Today's improved outcomes also are a consequence of the use of more reliable regional flaps and microsurgical techniques, which permit the early and simultaneous restoration of bone and soft tissue loss once all devitalized tissues have been adequately debrided.