Primary one-stage reconstruction of cheek defect after a shotgun blast to the face: Use of the latissimus dorsi musculocutaneous free flap for soft-tissue repair and facial reanimation

The authors describe a, case of a shotgun blast injury to the face in which early definitive repair of both facial soft tissues and facial reanimation was accomplished in one stage using a free flap. The trauma occurred 2 day s before presentation via a hunting rifle fired at a short range. On examin ation, a 8 x 5-cm cheek defect was evident, involving the full thickness of the perioral facial mimetic muscles as well. A free latissimus dorsi muscu locutaneous flap was transferred to the defect, with the thoracodorsal nerv e coapted to an ipsilateral, severed buccal branch of the facial nerve. Pos toperatively, the flap survived completely, with its skin paddle excised su bsequently in two stages. Good muscle movement was obtained, providing rest ing symmetry and a pleasant smile. Other than soft-tissue and bony defects resulting from shotgun injuries, ablation of the facial nerve or facial mim etic muscles may be an; important component of the defect that needs furthe r consideration. The authors conclude that the current technique of one-sta ge, early definitive repair of soft tissues and facial reanimation in such cases of facial shotgun blast injury offers the advantages of achieving bot h goals with one flap and accomplishing the procedure primarily in one stag e.