Challenges of reconstruction of complex gunshot facial trauma in a 15-year old girl victim of banditry. A case report

Background: Facial trauma can be from road traffic crash, assaults, suicidal attempts or gunshot injuries. Gunshot wound (GSW) to the face accounts for 6% of all GSW. It is usually extensive, complex and very challenging to manage, requiring skill, numerous surgical procedures, patience, and long term follow up. Definitive treatment can be immediate, early or delayed. The management consist of initial stabilization, definitive reconstruction and then secondary refinement. We present 11 year old girl who sustained complex, complete avulsion injury to the lower face following gunshot from attack by bandits in northwest Nigeria. She multiple free flap microvascular and multiple pedicled flap surgeries for reconstruction. Excessive and drooling of saliva, which was digesting the flap and immobilization of head and neck in pedicle flap were amongst major challenges. After 10 months of hospital admission, she he has achieved some degree of mouth closure, tolerating oral feeding, however, she has a 0.5cm diameter fistula of lower lip and cannot chew. She awaits further mandibular and soft tissue reconstructions. Reconstruction of facial GSW is challenging, surgery should be staged and pedicle flaps requires immobilization and control of excessive secretion of saliva. Keywords: Facial trauma, gunshot trauma, facial reconstruction, head and neck reconstruction