Evaluating the efficacy of recombinant human growth factors in scar remodelling for patients with facial soft tissue injuries.

Facial soft tissue injuries, often resulting in scarring, pose a challenge in reconstructive and aesthetic surgery due to the need for functional and aesthetic restoration. This study evaluates the efficacy of recombinant human growth factors (rhGFs) in scar remodelling for such injuries. A retrospective evaluation was conducted from January 2020 to January 2023, involving 100 patients with facial soft tissue injuries. Participants were divided equally into a control group, receiving standard cosmetic surgical repair, and an observation group, treated with rhGFs supplemented cosmetic surgery. The study assessed scar characteristics (pigmentation, pliability, vascularity, height), hospital stay duration, tissue healing time, complication rates and patient satisfaction. The observation group demonstrated significant improvements in all scar characteristics, with notably better pigmentation, pliability, vascularity and height compared with the control group. The rhGF treatment also resulted in reduced hospital stay duration and faster tissue healing. Notably, the total complication rate was significantly lower in the observation group (10%) compared with the control group (34%). Additionally, patient satisfaction levels were higher in the observation group, with 98% combined satisfaction compared with 76% in the control group. The application of rhGFs in treating facial soft tissue injuries significantly enhances scar remodelling, expedites healing, reduces complications and improves patient satisfaction. These findings establish rhGFs as a valuable tool in the management of facial soft tissue injuries, highlighting their potential in improving both functional and aesthetic outcomes.

Trends in opioid prescription for craniomaxillofacial trauma in the United States: An 11-year retrospective study of emergency room and office visits.

BACKGROUND: Facial trauma is associated with significant long-term morbidity and pain. These patients are routinely prescribed opioid medication and are at risk for opioid dependence. Rates and trends in opioid prescription in the ambulatory setting for management of craniofacial trauma are unknown. METHODS: The National Ambulatory Medical Care Survey and National Hospital Ambulatory Medical Care Survey data were analyzed from 2006 to 2016. Using International Classification of Diseases codes, 7,997,454 visits for craniomaxillofacial trauma were identified. Trends in opioid and nonopioid prescriptions were studied, with variables of interest including demographics, geographic region, expected source of payment, and injury location. RESULTS: Over the study period, trends in both opioid and nonopioid prescriptions remained stable, with about 13.4% of all visits receiving opioid prescriptions. Patients aged 18 to 44 (P < .001) and lower face trauma (P = .047) were associated with increased rates, while Medicare and charity payers (P < .001) were associated with lower rates of opioid prescriptions. There was no significant difference in prescription rates across geographical regions, by ethnicity, or sex. CONCLUSION: Opioid medication forms the cornerstone for ambulatory management of craniofacial trauma. Despite increased awareness and emphasis on multimodal pain management, opioid prescription trends have remained relatively stable over time.

Facing the facts on prophylactic antibiotics for facial fractures: 1 day or less.

BACKGROUND: To evaluate the role of initial prophylactic antibiotics on facial fractures, outcomes were compared between a short course (≤24 hours) of antibiotics to those who received an extended course (>24 hours). METHODS: Adults admitted (2010-2015) to a Level I trauma center intensive care unit with at least one facial bone fracture and major injuries isolated to the head and neck were included. Our primary analysis compared infectious complications of the head or neck (H/N infection) between patients given short or extended courses of antibiotic prophylaxis. Multivariate logistic regression and analysis of propensity score matched pairs were performed. RESULTS: A total of 403 patients were included, 85.6% had blunt injuries and 72.7% had their facial fracture managed nonoperatively. The H/N infection rate was 11.2%. Two hundred eighty patients received a short course of antibiotics and 123 patients received an extended course. Median Injury Severity Score was 14 in both groups (p = 0.78). Patients receiving an extended course of antibiotics had higher rates of H/N infection (20.3% vs. 7.1%, p < 0.001). Factors associated with development of H/N infection included younger age, penetrating injury, open fracture, upper face or mandible fracture, fractures in multiple facial thirds, vascular injury, hypertension, and extended antibiotic course. Multivariate logistic regression identified younger age (odds ratio [OR], 0.98; 95% confidence interval [CI], 0.96-1.00; p = 0.02), multiple facial third fractures (OR, 4.9; 95% CI, 2.4-10.2; p < 0.001), and penetrating mechanism (OR, 3.1; 95% CI, 1.5-6.4; p = 0.003) as independent predictors of H/N infection, but not antibiotic duration. Propensity score-matched analysis found no differences in H/N infection between short and extended antibiotic courses (11.4% vs. 12.5%; p = 1.0). Subgroup analyses demonstrated no differences in H/N infection between short or extended antibiotic courses by injury pattern, mechanism, or treatment (operative or nonoperative). CONCLUSION: These results lead us to believe that we should limit antibiotics to 24 hours or less upon admission for facial fractures. LEVEL OF EVIDENCE: Therapeutic/care management, level IV.

Invasive Cutaneous Facial Mucormycosis in a Trauma Patient.

Mucormycosis, also known as zygomycosis, is an aggressive infection caused by a ubiquitous group of molds known as mucormycetes and is often associated with immune suppression or trauma among immunocompetent populations. We present the case of a 19-year-old woman who was involved in a motor vehicle accident in whom rapidly progressive invasive cutaneous facial mucormycosis subsequently developed. The diagnosis, treatment options, and incidence of this disease process are discussed in the context of trauma.

O2C Laser Doppler and Digital Photo Analysis for Treatment Evaluation of Beta-Glucan versus Provitamin Pantothenic Acid of Facial Burns.

Various creams are available for superficial second-degree burns (SSDB) of the face. We evaluated provitamin pantothenic acid versus ß-glucan for SSDB of the face using the O2C laser Doppler system and digital photo analysis. Out of 20 patients (January to December 2012) with facial burns, 7 with SSDB of both cheeks were included to our study. Burned cheek wounds were treated using pantothenic acid or ß-glucan. Digital photos of marked regions were taken daily from predefined distances. Microcirculation was measured at marked regions for 7 days at scheduled time points using the O2C laser Doppler. Data were evaluated using the SPSS program (SPSS Inc., Chicago, IL). Wounds treated with ß-glucan showed faster reepithelialization. O2C laser Doppler measurements showed faster increase in SO2, microvascular perfusion, hemoglobin content, and blood flow. This correlated good with clinical Vancouver Scar Scale results. Although not statistically significant, ß-glucan cream therapy of SSDB results in aesthetically superior outcome and faster reepithelialization.

Utilização do retalho de Karapandzic para reconstrução de lábio inferior após trauma / The use of the Karapandzic flap for reconstruction of the lower lip after trauma

A reconstrução labial representa um desafio ao cirurgião plástico. Os lábios são o centro dinâmico do terço inferior da face, sendo fundamentais para mímica e expressão facial, fala, deglutição, sucção e contenção de secreções salivares, sem esquecer-se do componente estético. Portanto, a reconstrução labial deve ter como objetivo o restabelecimento funcional da estrutura lesada e um bom resultado estético. Este artigo relata um caso de lesão labial traumática grave e sua reconstrução, com a utilização do retalho de Karapandzic. Os autores demonstram sua funcionalidade e fácil execução, assim como seu resultado final.

Lip reconstruction is a challenge to the plastic surgeon. The lips are the dynamic center of the lower third of the face, being essential for facial movements and expression, speech, deglutition, suction, and containment of salivary secretions, as well as esthetic appearance. Therefore, the objective of lip reconstruction should be functional recovery of the damaged structure and a good esthetic result. This article reports a case of severe traumatic labial injury and reconstruction, using the Karapandzic flap. The authors demonstrate its functionality and easy implementation as well as the final result.

Contemporary update on the treatment of dog bite: injuries to the oral and maxillofacial region.

PURPOSE: The purpose of the present retrospective record review was to evaluate the patient demographics, treatment rendered, and long-term outcomes of patients injured in dog bite attacks to the oral and maxillofacial region. MATERIALS AND METHODS: In the present study, a retrospective medical record review was conducted of patients treated by the oral and maxillofacial surgery department at the University of Tennessee Medical Center who had presented with injuries to the head, neck, and face region from dog bite attacks from February 1, 2006 to October 31, 2013. Each patient included had to have had at least 1 follow-up visit. The data obtained from the patients' medical records included patient demographics, event details, injuries sustained, and treatment rendered and analyzed. RESULTS: The medical records from 20 patients were included and reviewed. More than one half (60%) of the patients were younger than 12 years old. The dog was owned by the patient or a relative in 58% of the cases. The children sustained injuries requiring hospital admission and repair in an operating room setting more often than did the adults. Pit bulls were more frequently associated with injuries than other breeds (9 of 20). CONCLUSIONS: Our patients required a total of 28 hospital inpatient days, 29 total procedures, and follow-up treatment for up to 2 years. Our review has shown the complexity of soft tissue injury treatment and the significant financial impact associated with dog bite injuries owing to the multiple hospital admissions, surgical revisions, and lengthy follow-up period required.

The effect of memantine on functional recovery of the facial nerve after crush injury.

The objective of this study is to establish whether memantine is an alternative and effective treatment on facial nerve recovery after crush injury, and also to analyze the effective doses of this promising agent. This is a randomized controlled animal study. 40 rats underwent crush injury to left main trunk of the facial nerve, and divided into 4 groups; (1) control (saline treated), (2) 5-mg/kg memantine, (3) 10-mg/kg memantine, and (4) 20-mg/kg memantine group. Facial nerve functions were evaluated by eye reflex, and whisker movement compared to the unaffected side. They were scored on a 3-point scale. On day 28, the rats were sacrificed, and the facial nerves were dissected. The paraffin sections were studied with caspase-3 immunostaining. According to statistical data, the recovery in Group 4 began significantly earlier than the other groups on the basis of restoring eye blink reflexes and whisker movement. Groups 2 and 3 showed faster recovery than Group 1 on the basis of whisker movement. The caspase-3 positive staining was rarely detected in all groups. The Kruskal­Wallis test revealed that Group 4 showed fewer apoptotic cells than other groups; this was statistically significant. However, the Mann­Whitney U test with the Bonferroni correction did not reveal any significant difference between the groups. In conclusion, this study revealed that memantine acted to restore facial nerve functions, and accelerate recovery after facial nerve injury by inhibiting apoptosis.

Facial skin breakdown in patients with non-invasive ventilation devices: report of two cases and indications for treatment and prevention.

Non-invasive ventilation (NIV) provides an effective ventilatory support in patients with respiratory failure without endotracheal intubation. However, there are potential problems with its clinical application and the development of pressure ulcers represents a common complication. Often several intensive care units treat facial skin breakdown related to NIV. In this article, we report our experience in treatment and prevention of these lesions, emphasising the higher risk of certain age groups to develop them, such as preterm infants and elderly patients with comorbidities. We performed daily disinfection of the lesions followed by application of topical cream containing hyaluronic acid (HA) sodium salt. In addition, in order to prevent worsening of injury, we applied a cushion made of gauze pad containing HA sodium salt between the skin and the masks, so as to reduce friction between the NIV devices and the skin. Local medical treatment allowed complete reepithelialisation of the injured skin areas. Systematic monitoring of patients' faces is essential to detect early damages and to intervene with appropriate therapy, especially in preterm infants and elderly. Moreover, refining the devices with the proposed protective cushion can reduce pressure ulcers and increase comfort for the patients.

Coadjuvant treatment with surgery and pirfenidone in severe facial trauma due to dog bite.

BACKGROUND: This case report assesses the effectiveness of surgery plus pirfenidone (PFD) as a concomitant therapy in the management of facial trauma after severe dog bite. METHODS: A 16-month-old female patient who suffered a severe attack by a big-sized dog (Rottweiler) in the midface area was managed with surgery/PFD combination and followed up for 20 months to evaluate the efficacy to control, prevent, and improve injury sequels. RESULTS: Surgery/PFD combination offered a good complementary therapy downregulating inflammatory activity, improving blood supply, and activating cytokine modulation and collagen synthesis/biosynthesis (scar control). No side effects were reported in this case report. CONCLUSIONS: Surgery/PFD management for severe facial dog bites represents a safe and effective therapeutic option to protect and improve a patient's quality of life, minimizing long-time sequels.

Use of botulinum toxin type A to improve treatment of facial wounds: a prospective randomised study.

BACKGROUND: The tension vectors acting on the wound edges are transmitted to immature collagen fibres synthesised during the normal healing phase. This accounts for scar widening as well as hypertrophic and hyperpigmented scars. The aim of our study was to evaluate whether early injections of botulinum toxin type A (BTA), which induces temporary muscular paralysis, decreases tension vectors on wound edges and enhances scarring of facial wounds. PATIENTS AND METHODS: Thirty patients with facial wounds were enrolled in this study and randomised into two groups with or without injection of BTA within 72 h postoperatively. BTA was injected into the facial muscles directly or indirectly involved in scar widening. Scars were assessed at a 1-year follow-up visit by patients using the Patient Scar Assessment Scale (PSAS) scale, by an independent evaluator using the Observer Scar Assessment Scale (OSAS) and the Vancouver Scar Scale (VSS), and by a board of six experienced medical specialists using the Visual Analogue Scale (VAS) with standardised photographs. RESULTS: At the 1-year visit, 24 patients were reviewed and six patients were lost to follow-up. No statistically significant differences were found between the two groups for the PSAS, OSAS and VSS scores. However, the median VAS rated by the six evaluators was 8.25 for the botulinum toxin-treated group compared with 6.35 for the control group. This result was statistically different, demonstrating improved scarring with BTA. CONCLUSIONS: Thanks to chemoimmobilisation, injections of BTA appear to improve cosmesis of facial wounds. Accordingly, they would be beneficial for use in young patients for wounds without tissue loss, lying perpendicular to the reduced tension lines of the skin of the face.

Postcraniofacial trauma multidrug resistant Acinetobacter baumannii infection treated with intravenous colistin: a rare complication.

Nosocomial meningitis is a rare complication of combined craniofacial and neurosurgical procedures. The increase in meningitis caused by multidrug-resistant (MDR) Acinetobacter baumannii has resulted in a significant reduction in available treatment options. We report a case of 52-year-old man who sustained a complex craniofacial trauma, who developed nosocomial MDR infection caused by A. baumannii in the wound. Patient was at significant risk of developing meningitis but, he was successfully treated with intravenous colistin. To conclude, patients with complex maxillofacial trauma are at high risk of MDR A. baumannii meningitis, especially in craniofacial intensive care units, and adequate infection control measures with proper institution of antibiotics, should be used to reduce the risk of this infection.

Effectiveness of cerium nitrate-silver sulfadiazine in the treatment of facial burns: a multicenter, randomized, controlled trial.

BACKGROUND: The face is a very frequent site of burn injuries. This multicenter, randomized, controlled trial thus investigates the effectiveness of cerium nitrate-silver sulfadiazine in the treatment of facial burns compared with silver sulfadiazine. METHODS: Adult patients with acute facial burns admitted to Dutch burn centers were randomized to treatment with either cerium nitrate-silver sulfadiazine or silver sulfadiazine. Primary outcome was need for surgery and time to wound healing. Aesthetic and functional outcome was assessed at 3, 6, and 12 months after burn. RESULTS: From March of 2006 until January of 2009, 179 patients were randomized and 154 could be included. The two groups of patients (cerium nitrate-silver sulfadiazine group, n=78; silver sulfadiazine group, n=76), were comparable regarding sex, age, percentage total body surface area burned, and cause. During admission, four patients died, leaving 77 and 73 patients for primary analyses, respectively. Surgery was required in 13 (16.9 percent) compared with 15 patients (20.5 percent) (p=0.57; odds ratio, 0.8; 95 percent CI, 0.3 to 1.8), respectively. Median time to wound healing was 11.0 days in the cerium nitrate-silver sulfadiazine group (interquartile range, 7.0 to 15.0) and 9.0 days for silver sulfadiazine group (interquartile range, 5.0 to 15.75) (p=0.17). There were no significant differences in functional and aesthetic outcome. CONCLUSIONS: No differences were found in effectiveness of both treatments. The vast majority of facial burns do not require surgery, and treatment with cerium nitrate-silver sulfadiazine and silver sulfadiazine leads to satisfactory outcome, both aesthetically and functionally. CLINICAL QUESTION/LEVEL OF EVIDENCE: Therapeutic, II.

[Cervico-facial traumatic injuries at the Donka national hospital of the teaching hospital of Conakry]. / Les Plaies Traumatiques Cervico-Faciales A L'Hopital National Donka Du CHU De Conakry.

The Cervico-Facial Traumatic Injuries (CFTI) can entrain complications and serious aesthetic and functional sequella. The objectives of this study were to determine the frequency of CFTI, to describe the clinical forms and to evaluate the treatment. It was a prospective study conducted from February to July 2010 in the National Donka hospital of the Teaching Hospital of Conakry. The study concerned 265 patients, who benefited a treatment and reevaluated. The young adults aged between 21-30 years were the most affected (38.49%). 74.34 % were men and 25.66 % were females with a sex ratio of 2.9. Road accident was the etiology of injuries in 70.57% of cases. Clinically, the lesions were dominated by the wounds type II (49.05 %) followed by the wounds type I (48.30 %) and 2,65 % of wounds was type III. The treatment was medical and surgical. Evolution was considered favorable in 82.13 % of cases and disfavorable in 17.85 % of cases.

Mechanical evaluation of the resistance and elastance of post-burn scars after topical treatment with tretinoin.

OBJECTIVE: After burn injuries, scarred skin lacks elasticity, especially in hypertrophic scars. Topical treatment with tretinoin can improve the appearance and quality of the skin (i.e., texture, distensibility, color, and hydration). The objective of this prospective study was to examine the effects of treatment with 0.05% tretinoin for one year on the biomechanical behavior and histological changes undergone by facial skin with post-burn scarring. SETTING: Tertiary, Institutional. METHOD: Fifteen female patients who had suffered partial thickness burns with more than two years of evolution were selected. Skin biopsies were obtained initially and after one year of treatment. The resistance and elastance of these skin biopsies were measured using a mechanical oscillation analysis system. The density of collagen fibers, elastic fibers, and versican were determined using immunohistochemical analysis. RESULTS: Tretinoin treatment significantly lowered skin resistance and elastance, which is a result that indicates higher distensibility of the skin. However, tretinoin treatment did not significantly affect the density of collagen fibers, elastic fibers, or versican. CONCLUSION: Topical tretinoin treatment alters the mechanical behavior of post-burn scarred skin by improving its distensibility and thus leads to improved quality of life for patients.

Extensive facial trauma caused by dog bites in woman suffering from systemic fluconazole-resistant Candida infection.

INTRODUCTION: Dog bites present a complex problem. Extensive facial trauma is a challenging problem to treat with priority for functional outcome. This paper describes the conservative treatment in a very difficult case of facial trauma with unusual infections due to the bites. CASE REPORT: A 45 year-old woman was admitted in hypovolaemic shock with amputation of nose, upper and lower lips, left cheek and chin caused by dog bites. After vital parameters and volaemy were stabilized, wound toilet was performed, followed by skin and mucosal rotation flaps and anterior nasal tamponade; the lesion has then been covered with a collagen/oxidized regenerated cellulose dressing and sterile gauzes. Culture test highlighted coagulase-negative Staphylococcus and Candida albicans. However after few days, the patient developed septic-undulant hyperpyrexia, retinitis, renal candidiasis, folliculitis. Systemic Candida infection resistant to fluconazole was diagnosed. Amphotericin B was given to the patient and the facial wound was managed conservatively with an active medication because of inoperability conditions. The outcome of the use of active medications was an immediate response with excessive granulation tissue followed by a rapid re-epithelization. CONCLUSION: As our case has shown, conservative treatment can be a valid alternative therapy in the treatment of large wounds with invasive candidosis and candidaemia or other major contraindications to surgery. In fact, in cases where surgical reconstruction is not a feasible option, conservative treatment can allow a rapid repair of the skin barrier.

Primary repair of facial dog bite injuries in children.

OBJECTIVES: The management of dog bite wounds is controversial, and current data on risk of infection are variable and inconsistent. Furthermore, the use of prophylactic or empiric antibiotics for the treatment of these wounds is debatable. We investigate the rate of wound infections and other complications after primary repair of pediatric facial dog bite injuries. METHODS: We reviewed 87 consecutive patients aged 18 years or younger who had facial dog bite injuries from January 2003 to December 2008. Variables examined were age, sex, setting of repair, number of sutures used for repair, whether surgical drains were used, and antibiotic administration. End points measured were incidence of wound infection, need for scar revision, and any wound complications. RESULTS: The mean age of patients was 6.8 years, and the majority were women (53%). All facial injuries were primarily repaired at the time of presentation either in the emergency department (ED; 46%), operating room (OR; 51%), or an outpatient setting (3%). All patients received an antibiotic course, none of the patients developed wound infection, and no subsequent scar revisions were performed. Three patients repaired in the OR underwent placement of a total of 4 closed-suction drains. The mean (SD) age of patients repaired in the OR was significantly younger than those repaired in the ED (5.7 [3.9] vs 8.0 [4.5] years, respectively; P < 0.01). The number of sutures used were greater for patients repaired in the OR than in the ED (66.4 [39.6] vs 21.7 [12.5], respectively; P < 0.01). CONCLUSIONS: Intuitively, younger patients and patients with greater severity injuries are more likely to undergo repair in the OR, and this was supported by our data. Overall, we found that primary repair of pediatric facial dog bite injuries, including complex soft-tissue injuries, is safe when performed in conjunction with antibiotic administration; however, further cross-specialty studies are needed to fully characterize these end points in a larger population.

Is prophylactic acyclovir treatment warranted for prevention of herpes simplex virus infections in facial burns? A review of the literature.

Both cosmetic facial resurfacing and facial burns cause an injury to the dermal layer of the skin. This injury renders the patient susceptible to primary herpes simplex virus (HSV) infection or, more commonly, to HSV reactivation. This in turn can lead to bacterial superinfection, possibly resulting in scarring and systemic dissemination in the immunosuppressed burn patient. HSV reactivation rates have been reported to be up to 50% in cosmetic procedures without acyclovir prophylaxis and up to 25% in patients with burn injury. Currently, acyclovir prophylaxis is a common practice in facial resurfacing, but no such recommendations have been issued for patients with burn injury. HSV usually presents in a febrile burn patient between the first and third postburn weeks as a cluster of small, umbilicated vesicles or vesicopustules on an erythematous base found within or around the margins of healing partial-thickness wounds. Diagnosis is confirmed through viral culture from the base of an unroofed vesicle, and treatment is begun with intravenous acyclovir. Antiviral prophylaxis should be strongly considered for HSV infection prevention in patients with major burn injury, particularly with burns involving the face. Acyclovir is the primary drug of choice, and contact precautions should be practiced. High suspicion levels and alertness to this entity can help prompt diagnosis and timely treatment while alleviating late complications.

Mechanical evaluation of the resistance and elastance of post-burn scars after topical treatment with tretinoin

OBJECTIVE: After burn injuries, scarred skin lacks elasticity, especially in hypertrophic scars. Topical treatment with tretinoin can improve the appearance and quality of the skin (i.e., texture, distensibility, color, and hydration). The objective of this prospective study was to examine the effects of treatment with 0.05 percent tretinoin for one year on the biomechanical behavior and histological changes undergone by facial skin with post-burn scarring. Setting: Tertiary, Institutional. METHOD: Fifteen female patients who had suffered partial thickness burns with more than two years of evolution were selected. Skin biopsies were obtained initially and after one year of treatment. The resistance and elastance of these skin biopsies were measured using a mechanical oscillation analysis system. The density of collagen fibers, elastic fibers, and versican were determined using immunohistochemical analysis. RESULTS: Tretinoin treatment significantly lowered skin resistance and elastance, which is a result that indicates higher distensibility of the skin. However, tretinoin treatment did not significantly affect the density of collagen fibers, elastic fibers, or versican. CONCLUSION: Topical tretinoin treatment alters the mechanical behavior of post-burn scarred skin by improving its distensibility and thus leads to improved quality of life for patients.