Microsurgical reconstruction of shotgun-blast wounds to the face.

Successful management of shotgun-blast injuries to the face with loss of composite tissue is discussed. While emphasis in the literature has generally been on weapons ballistics and their destructive effect on tissues, the most massive tissue destruction can be anticipated from close-range gun-barrel effects due to rapidly expanding gases. The authors stress uncommonly aggressive tissue transfer as the method of choice in reconstructing facial shotgun wounds. The surgeon must evaluate patient psychological readiness for step-by-step reconstruction. Fistulas are avoided by transplanting several small flaps, rather than one large flap. The dorsalis pedis flap is recommended as an excellent choice for contaminated intraoral reconstruction. A staged approach providing osteocutaneous composite tissue for repair of shotgun-blast facial wounds is presented. At subsequent stages, soft tissue defects are repaired and restoration of mandibular continuity is provided with the use of the scapular flap and other alternatives. Microsurgical management of facial gunshot wounds can provide satisfactory reconstruction and almost normal function.