Background
Self-inflicted gunshot wounds to the face cause devastating midfacial defects, and pose a challenge to the reconstructive surgeon Face transplantation has the potential to provide near-normal restoration in otherwise non-reconstructable defects Two out of 7 face transplant recipients at our institution had sustained self-inflicted gunshot wounds We illustrate the role of face transplantation in the management of self-inflicted gunshot wounds through an aesthetic, functional, and psychosocial examination of outcomes.
Methods
We performed a retrospective analysis of individuals with self-inflicted gunshot wounds who were screened for inclusion in our face transplantation protocol between 2008 and 2015. We collected data describing the patients' injuries, modes of conventional reconstruction, and deficits thereafter For those who received face transplants, we critically reviewed the psychosocial screening process and post-transplantation aesthetic, functional, and psychosocial outcomes.
Results
Six individuals post- self-inflicted gunshot wounds were screened for face transplantation All had undergone conventional reconstruction, with 5 receiving loco-regional flaps and free tissue transfers, and one undergoing serial debridement and primary soft tissue repair All suffered from residual functional and aesthetic deficits Two underwent partial face transplantation at our center and one is currently undergoing screening We describe the pre-transplant psychosocial screening process and the aesthetic, functional, and psychosocial outcomes of the self-inflicted gunshot wound transplant recipients.
Conclusions
We examined the injury imparted by self-inflicted gunshot wounds to the face, outcomes of conventional reconstruction, and how face transplantation offers a potentially superior solution. More importantly, we highlight the critical nature of the psychosocial component of the multidisciplinary evaluation given the history of mental illness and suicidal behavior in this subset of patients
Figure 1. SIGSWs patients following partial face transplantation.
