Anuradha, S (2013) Reconstruction of soft tissue injuries of the face. Masters thesis, Thanjavur Medical College, Thanjavur.
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Abstract
INTRODUCTION: Facial injuries themselves are rarely life threatening but are indicators of the energy of injury. The etiology of facial soft tissue trauma varies considerably depending on age, sex and geographic location. The true incidence is difficult to estimate because minor injuries go unreported and do not seek medical attention. The incidence of facial injuries is high in developing countries like India, than the developed. In Tamilnadu particularly in districts in & around Thanjavur the incidence is high. In the U.S , three million patients present to the emergency with facial injuries,accidental falls being the most common cause accounting for 48- 51%¸16% due to non-fall impact with structures such as door, wall¸ window¸ 16-32% due to assault¸ RTA contributed 50%, sport injuries 8%, dog bite 9%. Other causes account for the remainder including occupational injuries and human bites. Mechanism of injury for facial injuries varies from place to place depending on the degree of urbanization, socioeconomic status and cultural background. In rural areas domestic violence contribute to majority and in metropolitan areas Road traffic accidents contribute the main cause.Alcohol consumption is a major factor for those between the ages of 30 and 50 years. In this dissertation, I have analysed the various parameters associated with facial soft tissue injuries – mode of injury, site of injury and different methods of reconstruction. Historical and recent advances have enabled repair of most soft tissue injuries to the face, provided the nature of injury is carefully considered and a thoughtful reconstructive plan is used. AIM OF STUDY: The aim of my study is to collect patients with soft tissue injuries of face presented to our Department of Plastic and Reconstructive surgery, Thanjavur Government Medical College and Hospital, Thanjavur and analyse • The demographics of the injured population, • Socio economic status, • Alcohol influence, • Mode of injury, • Site of injury, • Anatomic region of the defect, • Reconstructive procedures – primary and secondary, • Rate of wound infection, • Hospital stay. MATERIALS AND METHODS: Materials: This study was conducted in the department of Plastic and Reconstructive surgery, Thanjavur medical college & Hospital from August 2010 to March 2013.The patients with history of facial soft tissue injuries who were admitted in the emergency ward were included in the study. Patients with severe life threatening CNS injuries, skeletal injuries and other injuries were excluded from the study. All patients with soft tissue injuries of the scalp, cheek, lip, ear, nose and eyelids accounting to 90 cases were included in the study. Methods; The methods included obtaining a thorough history of mode of injury, site of injury, thorough clinical examination and necessary investigations with appropriate surgical reconstruction.Initial care of trauma patients were done using the algorithmic protocol of ATLS (Advanced Trauma Life Support). Proper preoperative planning was done. Pattern & template were made as per tissue loss.Digital photographs of the patients were recorded preoperatively, intraoperatively and postoperatively. OBSERVATION AND RESULTS: The data shows that about 51% (n = 46) patients belonged to 21-40 years. 37% (n=33) of patients belonged to 41-60years age group and 12%(n=11) of patients were less than 20years. Out of 90cases 71%(n=64) of patients were males and 29%(n=26) were females. The chart shows that 49%(n=44) of victims are from Thanjavur district, 16%(n=14) are from Thiruvarur district, 9%(n=8) from Nagapattinam district, 12%(n=11) from Pudukottai district,10%(n=9) from Ariyalur district and 4%(n= 4) from Trichy district. Road traffic accidents were the commonest cause for facial injuries contributing 49%(n=44) and other causes being accidental falls 12%(n=11) , Assault 19%(n=17) Occupational 6%(n=5), Human bite 11%(n=10) and Animal bites 3%(n=3). Ear injuries predominated being 30% (n=27) followed by Eyelid and lip injuries contributing 15% each (n=14each) then the scalp and forhead 13% each (n=12 each), nose 9% (n=8) and cheek 8%(n=7). The average hospital stay for reconstruction of scalp and forehead was 10 days, Eyelid 8 days, Cheek 6 days, Nose 5 days, Ear 4 days and Lips 4 days. Among scalp defects temporal region contributed 39%, Parietal and Frontal regions 23% each and forehead 15%. Primary reconstruction was done in 2 cases (15.38%) in the emergency operation theatre and secondary reconstruction was done in 11cases (84.62%) in elective operation theatre. Rotation flaps were done in 4 cases (30%), Transposition flap in 3 cases (23%), Galeal flaps and Split skin thickness graft in 1 case each (8%), Full thickness skin graft and primary suturing in 2 cases each (15%) CONCLUSION: Facial injuries themselves are rarely life threatening, but are indicators of energy of injury. Road traffic accidents being the common cause for facial and head injuries may be prevented by using helmets. The economically productive age group of 21-40 years were commonly injured there by decreasing the income of the population. Males outnumbered the females, majority of cases belonged to low socio economic status from villages. In reconstruction of ear injuries for upper third defects superiorly based postauricular flap was ideal. For middle third defects converse tunnel, Dieffenbach and bipedicle flap gave good results. Double cross skin flap gave good aesthetic results in lobule reconstruction. Scalp defects managed with rotation flaps gave good aesthetic hairbearing skin when compared to transposition flaps. Cheek injuries sutured primarily gave equal results as local flaps. Lip injuries sutured primarily and Schuchardt advancement flap gave good aesthetic results.Eye lid injuries when treated primarily gave good aesthetic and functional results. For lower lid injuries both Mustarde and Nasolabial flaps gave good equal results. In nose reconstruction oblique forehead flaps gave good results.
| Item Type: | Thesis (Masters) |
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| Uncontrolled Keywords: | Reconstruction ; soft tissue injuries ; face. |
| Subjects: | MEDICAL > Plastic and Reconstructive Surgery |
| Depositing User: | Kambaraman B |
| Date Deposited: | 12 Oct 2017 02:07 |
| Last Modified: | 12 Oct 2017 02:07 |
| URI: | http://repository-tnmgrmu.ac.in/id/eprint/3588 |
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