Definition

Injuries of the facial soft tissue are either isolated in the form of abrasions, lacerations, incisions, crushed wounds, defect wounds or as part of severe traumas in combination with craniofacial fractures. The period between injury and treatment and the kind of primary wound treatment is of vital importance for future functionality and for the aesthetic result, which is especially important for the face.

Therapeutic Goals

Restoration of the form and function (e.g. pigmentation, texture, hair growth, lid and lip closure)
Restoration of the aesthetics
Restoration of tissue defects
Restoration and preservation of the sensory and mororic nerve function
Restoration and preservation of the salivary glands and the salivary gland excretory ducts
Restoration and preservation of the function of the lacrimonasal duct
Reduction of scarring

Therapy Indications

Clinical evidence of laceration, abrasion, haematoma or loss of soft tissue
Degree of associated osseous facial injuries including injuries of cartilaginous structures
Sensory and/ or motoric nerve dysfunction (infra-, supra-orbitalis nerve, mental nerve, facial nerve)
Burns (e.g. chemical, thermal and/ or electrical)
Xenolith

Examinations
Inspection
Palpation
If indicated, x-rays
Computer tomography
Magnetic resonance tomography
Chemical laboratory tests (e.g. glucose test of the nasal secretion in the case of suspected liquorrhoea)

Treatment

Primary treatment measures are the removal of dysfunctions, e.g. air passage obstruction or the suppressing of major bleeding, so that vital endangering can be ruled out.
Debridement of soft tissue wounds
Xenolith removal from the wound
Treatment of soft tissue injuries
Correction and/ or reconstruction of the lacrimonasal duct
Correction and/ or reconstruction of the salivary gland excretory ducts
Nerve sulture (e.g. facial nerve)
Surgical treatment of soft tissue wounds (muscle, fascia, skin)
Reconstruction of soft tissue by means of split-thickness skin, full-thickness skin, pendiculated and/ or microvascular skin transplantation
Drainage of infected wounds or cavities

Additional Measures
Analgesic therapy
If indicated, antibiotic therapy

Recommendations

Major reconstructive measures, like for example microvascular reconstructions, should be performed in a two steps procedur in order to prevent a transplant loss caused by an infection.

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