By Admin The management of facial degloving injuries requires a combination of immediate surgical interventions and staged reconstructive strategies to restore both function and aesthetics. Below are the most effective surgical techniques, supported by clinical evidence and outcomes:
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1. Immediate Debridement and Tissue Salvage
The first priority is thorough debridement to remove non-viable tissue and reduce infection risk. Viable skin flaps are meticulously cleaned and preserved for reattachment. In cases where the degloved skin remains partially attached, surgeons reposition and suture it like a “jigsaw puzzle” to restore anatomical alignment.
2. Reattachment with Microsurgical Revascularization
When the degloved tissue retains adequate blood supply, microsurgical techniques are employed to reconnect blood vessels (revascularization). This approach is critical for preserving tissue viability, especially in injuries involving the nose, eyelids, or cheeks. For example, medial and lateral canthopexies stabilize eyelids, while microsutures reattach avulsed facial muscles.
3. Local and Regional Flaps
Local flaps are prioritized for their superior color and texture match to facial skin:
- Forehead flaps (based on supraorbital/supratrochlear vessels) reconstruct defects in the forehead or nasal dorsum.
- Nasolabial flaps cover cheek or nasal defects.
- Temporoparietal fascia flaps provide thin, pliable tissue for midface reconstruction.
These flaps maintain their own blood supply, enhancing survival rates compared to free grafts.
4. Skin Grafting
When primary closure or flaps are impractical, split- or full-thickness skin grafts are used:
- Split-thickness grafts (harvested from thighs) cover large defects but may contract over time.
- Full-thickness grafts (from the neck or clavicle) offer better cosmetic results for smaller areas.
Grafts are often combined with negative-pressure wound therapy (NPWT) to improve adherence.
5. Cartilage and Bone Reconstruction
Severe injuries involving exposed bone or cartilage loss require autologous grafts:
- Costal cartilage grafts (from ribs) rebuild nasal dorsum or columella.
- Calvarial bone grafts address frontal sinus or orbital rim defects.
6. Staged Reconstructive Surgeries
Complex cases often require multiple procedures:
- Primary repair: Initial debridement, fracture fixation (e.g., mandibular plating), and soft-tissue stabilization.
- Secondary reconstruction: Flap refinement, cartilage grafting, or scar revision after 4–6 weeks.
Key Considerations for Success
- Airway management: Early intubation or tracheostomy may be needed for midface injuries.
- Multidisciplinary care: Collaboration between maxillofacial surgeons, ophthalmologists, and ENT specialists improves outcomes.
- Postoperative care: Rigorous wound care, antibiotics, and physical therapy minimize complications like infection or contractures.
Outcomes and Challenges
Techniques like local flaps and microsurgery achieve 90–95% tissue survival in optimal cases. However, challenges persist, including:
- Scarring and asymmetries requiring secondary revisions.
- Sensory deficits in reinnervated areas.
- Psychological impacts of disfigurement, necessitating long-term counseling.
By combining meticulous tissue handling, staged approaches, and modern microsurgery, surgeons can restore both form and function in degloving injuries, though patient-specific factors heavily influence final results.