Face Avulsion and Degloving

Even though they are uncommon, facial avulsion and degloving injuries provide serious difficulties for reconstructive surgeons. Although specific regions including the nose, eyelids, ears, and mandible have been documented, hemi-facial degloving is still quite rare. We report a case of post-assault degloving including the face, lower and upper eyelids, nose, forehead, and part of the anterior wall of the frontal sinus. By using local flaps, graded surgical operations, and careful planning, we were able to provide the patient with a good cosmetic and functional result. This example emphasizes how crucial it is to use the right management techniques to treat complicated face injuries in order to improve patient satisfaction and quality of life.

Introduction:

Complex reconstructive challenges arise from facial avulsion and degloving injuries, which are defined by the separation of skin and soft tissues from underlying structures. While the nose, eyelids, ears, and mandible are among the facial regions where these injuries might occur, hemi-facial degloving is an extremely uncommon manifestation. In this instance, we present a multi-facial structure post-assault facial degloving case and talk about the surgical therapy strategy used to get the best results.Facial avulsion and degloving injuries can result in significant functional and aesthetic impairments, requiring a comprehensive approach to reconstruction. Hemi-facial degloving, although rare, presents unique challenges due to the extensive involvement of multiple facial structures. In this case study, we will discuss the surgical techniques employed to restore both form and function in a patient with a multi-facial structure post-assault facial degloving injury. The surgical therapy strategy utilized in this case involved a staged approach to address the various components of the facial degloving injury. The initial phase focused on debridement and wound closure, followed by reconstruction of the underlying bony structures and soft tissues. This comprehensive approach allowed for optimal restoration of both aesthetic appearance and functional abilities, resulting in a successful outcome for the patient. 

Case Presentation:

We describe the case of a patient who suffered a post-assault degloving injury affecting the cheek, upper and lower eyelids, nose, and a portion of the forehead along with the anterior wall of the frontal sinus. Due to the patient’s severe soft tissue loss and altered facial architecture, restoration would be extremely difficult. By using a phased procedure that included careful surgical planning, tissue alignment, and the use of local flaps, we were able to successfully restore the damaged parts’ functional integrity as well as their attractive look.The patient’s initial assessment revealed significant functional impairments, including difficulty with blinking, breathing, and facial expression. Additionally, the psychological impact of the disfigurement was evident, leading to decreased self-esteem and social withdrawal. However, through meticulous reconstruction and close collaboration with the patient’s multidisciplinary team, we were able to achieve not only functional restoration but also significant improvement in the patient’s quality of life and psychosocial well-being. The patient’s initial assessment also highlighted the challenges they faced in daily activities such as eating, speaking, and even basic facial movements. Furthermore, the disfigurement had a profound impact on their interpersonal relationships, causing them to feel isolated and experience difficulties in social interactions. However, with the comprehensive approach taken by the multidisciplinary team, we were able to address these issues and provide the patient with a renewed sense of confidence and improved overall functioning. 

Discussion:

To maximize results, facial degloving injuries necessitate a complete strategy that includes precise surgical technique, thorough assessment, and stepwise repair. Preservation of important structures, restoration of facial symmetry and contour, and reduction of donor site morbidity are important factors to take into account while managing such injuries. Depending on the severity and degree of the injury, a variety of surgical procedures, such as microvascular free tissue transfer, tissue expansion, and local flaps, may be used. To address both the functional and cosmetic aspects of facial restoration, cooperation with multidisciplinary teams comprising plastic surgeons, otolaryngologists, and ophthalmologists is imperative.These teams work together to ensure comprehensive care and optimal outcomes for patients with facial injuries. Additionally, ongoing follow-up and rehabilitation are crucial to monitor progress and address any potential complications that may arise during the healing process. Furthermore, psychological support and counseling should be provided to patients as they navigate the emotional and psychological impact of facial injuries. This holistic approach to care helps patients not only physically recover but also regain their confidence and quality of life. 

Conclusion:

In reconstructive surgery, avulsion and degloving injuries of the face—especially hemi-facial degloving—present specific difficulties. Restoring both functional integrity and aesthetic appeal can be satisfactorily accomplished with careful planning, phased surgical procedures, and the use of local flaps. In the treatment of complicated facial injuries, this instance underscores the value of a multidisciplinary approach as well as the necessity of continual study and innovation. We can further improve results and patients’ quality of life with facial degloving injuries by expanding our knowledge and honing surgical techniques.By staying up-to-date with the latest advancements in facial reconstruction, surgeons can enhance their ability to address complex cases and minimize potential complications. Additionally, collaboration among various medical specialties, such as plastic surgeons, maxillofacial surgeons, and ophthalmologists, can provide a comprehensive and holistic approach to the management of hemi-facial degloving injuries.