[MinervaXXIV]

A 21-year-old male presented to the emergency department with an extensive facial laceration after being assaulted with a machete. He was oriented 3 times but hypotensive, tachycardic, and tachypneic due to blood loss. A primary survey was done and he had emergency intubation. Intravenous crystalloid solution was started and a compressive wound dressing was placed. Following fluid replacement, he was transferred to the operating room for repair of his injuries. The laceration extended from the forehead above his left eye to right cheek going inferiorly in a tangential fashion to include his nose, infraorbital region and upper lip (Figure 1).


Figure 1: Frontal clinical view of complex maxillofacial injury. Soft tissue is reflected exposing fractured nasal cavity and maxilla.

Skeletal injuries included a coronal fracture of the nasal bones and a segmental separation of the anterior maxilla. In the operating room, emergency orotracheal intubation was switched to a submental intubation allowing simultaneously repositioning of the nasal fragments and intermaxillary fixation. Bony segments were embedded in the flap and were approached through the laceration. The wound was thoroughly irrigated, hemostasis was obtained, and the bone segments were stabilized with titanium miniplates and screws (Figure 2).


Figure 2: Frontal clinical view of soft tissues repositioning after stable fixation of maxillary and nasal fractures with titanium osteosynthesis.

Nasal stints were placed to favour nasal mucosa secondary healing and soft tissues closure was performed in layers (Figure 3).


Figure 3: Frontal clinical view after suturing of soft tissues and placement of nasal stents. Note cyanotic coloring of distal portion of flap.

He was extubated at the end of the procedure. Follow-up 3 weeks later was unremarkable, with no skin necrosis or wound dehiscence.

[ride]

Where do you fucking start with shit like this? I can't even put ikea furniture together, let alone something like a face. Props to the surgeon. Dude lives to die in the near future.

[Pt109fan]

Incredible surgical work. Helping people become well after such a horrific injury is Humanity at its Best.
I wish the Eugenicists destroying the world would use their talents for Good Works instead of their evil agenda.

[icehole]

if it was in the face shouldn't it be demasking instead of degloving?
serious question here

[kellyhound]

pretty good job done by the surgeons

[Karma]

Incredible surgery performed.

[Pyramid_Head]

Wow, he's lucky considering how extensive his injuries were.

[Sebring]

Originally Posted by ride ↗

Where do you fucking start with shit like this? I can't even put ikea furniture together, let alone something like a face. Props to the surgeon. Dude lives to die in the near future.

The tissue is all there, but it takes a surgeon with a crap ton of patience to sort through everything. And a patient OR team. And a lot of giant bladders.