Free tissue reconstruction of massive facial trauma - review of the literature and considerations to implement aesthetic and functional outcome
Open accessAbstract
The surgical armamentarium for the treatment of massive facial trauma has undergone a dramatic shift from early management strategies. Although tenants of acute trauma management continue to prioritize airway management and cardiopulmonary support, improved functional outcomes are achievable with an emphasis on early definitive free tissue transfer. The use of workhorse donor flaps, such as the radial forearm, fibula, and latissimus, have become the standard of care. An emphasis is placed on the separation of cranial, sinonasal, and oral contents and restoration of form and function. Here, we also discuss the management of telecanthus, nasal defects, and microstomia - sequelae which represent unique challenges to the reconstructive surgeon. The ability to perform virtual surgical planning and facial transplantation will likely shape future paradigms and represent the need to perform ongoing research.
AI snapshot
Written from the paper’s full text.
TL;DR
This narrative review describes a three-phase approach to massive facial trauma reconstruction, emphasizing early definitive free tissue transfer with workhorse flaps and later aesthetic/functional refinement. It also reviews special challenges such as telecanthus, microstomia, and total nasal reconstruction, and discusses virtual surgical planning and facial transplantation as emerging options.
Key findings
- Early definitive free tissue transfer after 72 h is favored over delayed reconstruction to minimize scar contracture, reduce infection risk, and improve long-term function; the senior author’s 49-patient case series reported no flap failures, excellent/very good cosmesis, and 98% per oral alimentation without gastrostomy tube feeding.
- The fibula osteocutaneous free flap is the workhorse for segmental mandibular defects, with free vascularized osseous tissue recommended for bony defects > 5 cm and up to 25 cm of bone harvestable while preserving proximal and distal 6 cm at the knee and ankle.
- Virtual surgical planning showed benefits in cited studies: May et al. reported 28 VSP-guided fibula reconstructions with decreased nonunion (20% vs. 4%) and shorter operating room time by 70 min; Seruya et al. found reduced ischemia time (170 to 120 min) despite more osteotomies (2 vs. 1); Navarro Cuéllar et al. found ~95% dental implant success in both groups and 100% bony opposition with VSP vs. 83% standard.
- Facial transplantation has been performed more than 40 times worldwide, with 10-year allograft survival exceeding 80%; the first US face transplant followed 23 prior procedures and 4 failed free flaps, and lifelong triple-drug immunosuppression remains the greatest challenge.
Methods
- Narrative literature review with illustrative case examples, not a systematic review; no formal search strategy, inclusion criteria, or quantitative synthesis are stated.
- Synthesizes prior studies and institutional/senior author experience, including a 49-patient case series and multiple case figures.
- Main analysis is qualitative: describes phased management, donor flap selection, and outcomes for massive facial trauma reconstruction.
Limitations
- Stated in the paper: there is a paucity of large-scale studies regarding the epidemiology and treatment of massive facial trauma patients; inferences are made by combining related trends with anecdotal and institutional experience.
- Evident from the text: this is a narrative review without systematic search or meta-analysis, relying on selected literature, case reports, and single-institution experience, which limits generalizability.
- Evident from the text: no formal limitations section is provided, and the senior author discloses being an educational consultant for Stryker Corp.
Model-written summary. Check it against the paper before relying on it.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
0 of 40 cited sources checked · 0 supported · 0 flagged
- Premisecitation
Gurunluoglu et al. demonstrate that the gracilis free flap is useful for lower lip defects in ballistic injuries, with 3/3 patients regaining speech and oral competence.
“Gurunluoglu et al. [34] demonstrate that the gracilis free flap is useful for lower lip defects in ballistic injuries in particular, with 3/3 patients regaining speech and oral competence.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [34]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Interpretationreasoning
After stabilization of the initial injury, early definitive free tissue transfer performed after 72 h results in improved function and cosmesis.
“After stabilization of the initial injury, early definitive free tissue transfer performed after 72 h results in improved function and cosmesis.”
Quote in the paperNot a substantial claim - Premisecitation
Computer-aided craniofacial reconstruction reduced ischemia time from 170 to 120 min compared to conventional reconstruction.
“Seruya et al. [40] compared 10 computeraided reconstructions of the craniofacial region to 58 conventional reconstructions and found a reduction in ischemia time from 170 to 120 min.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [40]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Interpretationnone given
One major limitation of autologous free tissue transfer is the satisfactory reconstruction of the central face and mimetic structures such as the lips and eyelids.
“One major limitation of autologous free tissue transfer is the satisfactory reconstruction of the central face and mimetic structures such as the lips and eyelids.”
Quote in the paperSubstantial claim - Premisecitation
Early reconstruction reduces infection risk.
“Many advantages include minimization of scar contractures of facial soft tissues, reduced infection risk, and improved long-term function [2,[16][17][18][19] .”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [2,[16][17][18][19]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Premisecitation
Early reconstruction improves long-term function.
“Many advantages include minimization of scar contractures of facial soft tissues, reduced infection risk, and improved long-term function [2,[16][17][18][19] .”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [2,[16][17][18][19]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Premisecitation
VPS-guided fibula reconstruction using 3D-printed surgical guides significantly decreased nonunion rate (20% vs 4%).
“There was a significant decrease in nonunion rate (20% vs. 4%) and complications, with fewer flap losses and fistula.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [39]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Premisecitation
The fibular osteocutaneous free flap has become the workhorse of mandibular reconstruction for segmental defects in the setting of trauma.
“The fibular osteocutaneous free flap has become the workhorse of mandibular reconstruction for segmental defects in the setting of trauma [2,21,22] .”
Quote in the paperNot a substantial claim0 of 3 sources checked- cites [2]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites [21]
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- cites [22]
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- Premisecitation
Hanasono and Langstein report that extending the traditional Karapandzic flap technique to include tissue from the perioral cheek allows near-total lower lip defects to be reconstructed with sensation and dynamic function.
“Hanasono and Langstein [30] report the extension of the traditional Karapandzic flap technique to include tissue from the perioral cheek, allowing near-total lower lip defects to be reconstructed with sensation and dynamic function.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [30]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Premisecitation
On unblinded review of post-operative CT scan, the VSP-aided group had improved postoperative fibula positioning, with 100% bony opposition vs 83% in the standard group.
“On unblinded review of post-operative CT scan, the VSP-aided group was observed to have improved postoperative fibula positioning, with 100% bony opposition in the VSP group vs. 83% in the standard group, with improved vertical distance change and horizontal shift in the VSP group.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [41]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Interpretationreasoning
The paradigm of management for massive facial trauma patients has shifted from delayed to more definitive primary reconstructive efforts.
“This has led to a shift in the paradigm of management for massive facial trauma patients from delayed to more definitive primary reconstructive efforts.”
Quote in the paperSubstantial claim - Premisecitation
VSP-aided and standard maxillary reconstruction with dental implants both had high rates of dental implant success at approximately 95%.
“Navarro Cuéllar et al. [41] also compared VSP-aided maxillary reconstruction with dental implants to standard surgery (both techniques using a fibular free flap) and found that both had high rates of dental implant success at approximately 95%.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [41]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Premisecitation
In that case series, 98% achieved per oral alimentation without need for gastrostomy tube feeding.
“Previously, the senior author reported on a case series of 49 patients treated with an approach emphasizing early reconstruction undergoing free tissue transfer for severe facial trauma with excellent success rates -no flap failures, excellent/very good cosmesis, and 98% per oral alimentation without the need for gastrostomy tube feeding [2] .”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [2]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Premisecitation
Local reconstructive techniques, including cheek advancement techniques, Karapandzic flaps, and commisuroplasties, are highly effective in restoring defects of less than 80% of the lips.
“To that end, local reconstructive techniques, including cheek advancement techniques, Karapandzic flaps [Figure 4A-D], and commisuroplasties, are highly effective in restoring defects of less than 80% of the lips [29][30][31][32] .”
Quote in the paperSubstantial claim0 of 4 sources checked- cites [29]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites [30]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites [31]
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- cites [32]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Premisecitation
The need to separate exposed dura from the sinonasal cavity is of paramount importance in high-energy upper- and mid-face injuries.
“Therefore, the need to separate exposed dura from the sinonasal cavity is of paramount importance [16] .”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [16]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Premisecitation
In cases of total nasal reconstruction, the paramedian forehead flap for cutaneous reconstruction has been successfully combined with the radial forearm flap for nasal lining.
“In cases of total nasal reconstruction, there has been successfully combining the paramedian forehead flap for cutaneous reconstruction with the radial forearm flap for nasal lining [36] .”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [36]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Premisecitation
VPS-guided fibula reconstruction shortened operating room time by 70 min.
“Operating room time was also shorter in the VSP group by 70 min.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [39]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Premisecitation
Early reconstruction minimizes scar contractures of facial soft tissues.
“Many advantages include minimization of scar contractures of facial soft tissues, reduced infection risk, and improved long-term function [2,[16][17][18][19] .”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [2,[16][17][18][19]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Interpretationreasoning
Facial transplantation has evolved as a last-resort option to reconstruct defects from massive facial trauma failing free flap repair.
“To that end, facial transplantation has evolved as a last-resort option to reconstruct defects from massive facial trauma failing free flap repair.”
Quote in the paperNot a substantial claim - Premisecitation
Mechanisms capable of generating massive facial trauma wounds impart locoregional tissue changes including evolving tissue loss, distortion of normal landmarks, muscular attachment disruption, and an overall deficit of tissue bulk, both soft tissue and bone.
“Mechanisms capable of generating massive facial trauma wounds impart a number of locoregional tissue changes that create challenges for definitive primary repair, including evolving tissue loss, distortion of normal landmarks, muscular attachment disruption, and an overall deficit of tissue bulk, both soft tissue and bone [2,[9][10][11] .”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [2,[9][10][11]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Premisecitation
Larger skull base defects are well suited to reconstruction with the thin and broad latissimus muscle free flap covering custom implants from biocompatible materials such as titanium or polyetheretherketone.
“Larger skull base defects are well suited to reconstruction with the thin and broad latissimus muscle free flap covering custom implants from biocompatible materials such as titanium or polyetheretherketone [16] .”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [16]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Premisecitation
Post-operative telecanthus after transnasal wiring is due to lateral forces exerted by contracting tissues of the NOE region.
“This is due to the lateral forces exerted on by contracting tissues of the NOE region, and authors often advocate for miniplate fixation of the comminuted NOE complex with an emphasis on overcorrection [27] .”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [27]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Premisecitation
In a case series of 49 patients with severe facial trauma treated with early reconstruction and free tissue transfer, there were no flap failures.
“Previously, the senior author reported on a case series of 49 patients treated with an approach emphasizing early reconstruction undergoing free tissue transfer for severe facial trauma with excellent success rates -no flap failures, excellent/very good cosmesis, and 98% per oral alimentation without the need for gastrostomy tube feeding [2] .”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [2]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- Interpretationcitation
Over time, early reconstruction has gained favor over delayed reconstruction.
“Over time, early reconstruction has gained favor over delayed reconstruction.”
Quote in the paperSubstantial claim - Premisecitation
No significant difference was observed in the number of subsequent revision or secondary procedures between computer-aided and conventional groups.
“However, no significant difference was observed in the number of subsequent revision or secondary procedures between the computer-aided and conventional groups.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [40]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- May combine two claims. 10
- Classified as probably not a substantial claim. 10
May combine two claims.
Findingown dataIn a patient with full-thickness nasal deformity, total nasal reconstruction using mucosal advancement, septal mucosal flaps, cranial bone grafts, paramedian forehead flaps, and a cantilevered split calvarial bone graft resulted in improved projection, maintenance of bilateral nasal airways, and adequate symmetry.
“Employing these techniques together over a period of approximately 4 years, the final nasal reconstruction demonstrates improved projection, maintenance of bilateral nasal airways, and adequate symmetry [Figure 5F].”
Quote in the paperSubstantial claimMay combine two claims.
PremisecitationPrior to free tissue transfer, non-vascularized bone grafts were the primary technique used to restore rigid facial structure, but they were met with significant issues including resorption and inability to reconstruct larger defects due to lack of vascularity.
“Prior to the implementation of free tissue transfer, non-vascularized bone grafts were the primary technique used in order to restore the rigid facial structure on top of which soft tissues could be manipulated.These efforts were met with significant issues, among which were resorption and relative the inability to reconstruct larger defects due to their lack of vascularity [12] .”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [12]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
May combine two claims.
PremisecitationShort-term outcomes of facial transplantation have been excellent, with full graft take, recovery of sensory and motor nerve function, and improved cosmesis and quality of life being the norm.
“Short-term outcomes have been excellent, with full graft take, recovery of sensory and motor nerve function, and improved cosmesis and quality of life being the norm [10,42,43] .”
Quote in the paperNot a substantial claim0 of 3 sources checked- cites [10]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites [42]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
- cites [43]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
May combine two claims.
PremisecitationRecreating support structures for nasal defects maintains projection and contour within the reconstructed soft tissue envelope but requires cantilevered bone grafting when the nasal bones are lost due to injury.
“Recreating support structures for these defects maintains projection and contour within the reconstructed soft tissue envelope but requires cantilevered bone grafting in situations where the nasal bones are lost due to injury [37] .”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [37]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Probably not a substantial claim: may not pass S3 (load-bearing).
Premisenone givenTelecanthus results from severe upper- and mid-face trauma causing injury to the naso-orbito-ethmoid complex and disruption of the medial canthal tendon attachments.
“Telecanthus results from severe upper-and mid-face trauma causing injury to the naso-orbito-ethmoid complex and disruption of the medial canthal tendon attachments.”
Quote in the paperNot a substantial claimProbably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationRelative indications for facial transplantation have been stated as defects that are severe and involve the central face, including both upper and lower lids and upper and lower lips.
“Relative indications for facial transplantation have been stated as being defects that are severe and involved the central face, including both upper and lower lids and upper and lower lips [42] .”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [42]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
May combine two claims.
PremisecitationFree bone grafts can be utilized to provide the underlying framework of the orbital rims, recreate intercanthal distance, and provide adequate projection of the reconstructed nose.
“Free bone grafts can be utilized to provide the underlying framework of the orbital rims, recreate intercanthal distance, and provide an adequate projection of the reconstructed nose [9] .”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [9]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Probably not a substantial claim: may not pass S3 (load-bearing).
Interpretationnone givenThe long vascular pedicle of the fibula free flap is especially advantageous for mid-face reconstruction when a significant length is required to reach recipient artery and veins of the neck.
“In addition, the long vascular pedicle of the fibula free flap is especially advantageous for mid-face reconstruction when a significant length is required to reach the recipient artery and veins of the neck.”
Quote in the paperNot a substantial claimMay combine two claims.
PremisecitationAlthough 10-year allograft survival exceeds 80%, the greatest challenge of facial transplantation is the need for lifelong triple-drug immunosuppression.
“Although 10-year allograft survival exceeds 80% [44] , the greatest challenge is the need for lifelong triple-drug immunosuppression.”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [44]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Classified as probably not a substantial claim.
PremisecitationIn that case series, cosmesis was excellent or very good.
“Previously, the senior author reported on a case series of 49 patients treated with an approach emphasizing early reconstruction undergoing free tissue transfer for severe facial trauma with excellent success rates -no flap failures, excellent/very good cosmesis, and 98% per oral alimentation without the need for gastrostomy tube feeding [2] .”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [2]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Probably not a substantial claim: may not pass S4 (based).
Interpretationnone givenFor severe central face defects, facial transplantation is evolving as a viable option.
“For severe central face defects, facial transplantation is evolving as a viable option.”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim. May combine two claims.
PremisecitationWhile non-vascularized bone grafts may be used for bony defects <5 cm, free vascularized osseous tissue is recommended for bony defects >5 cm.
“While non-vascularized bone grafts may be used for bony defects < 5 cm, it is recommended to utilize free vascularized osseous tissue for bony defects > 5 cm [23] .”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [23]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationFutran et al. proposed a three-phased approach emphasizing early definitive reconstruction when possible.
“Futran et al. [2] (senior author) proposed a three-phased approach emphasizing early definitive reconstruction when possible (see Figure 1).”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [2]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
May combine two claims.
PremisecitationGold standard treatment for telecanthus is transnasal wiring of disrupted medial canthal tendons, but even then, the incidence of post-operative telecanthus can be up to 14% in some series.
“Gold standard treatment is transnasal wiring of disrupted medial canthal tendons, but even then, the incidence of post-operative telecanthus can be considerable, up to 14% in some series [25] .”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [25]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Probably not a substantial claim: may not pass S2 (checkable), S4 (based). May combine two claims.
Interpretationnone givenIntercanthal distance should be optimized in early definitive reconstruction, as delayed revision is particularly challenging.
“Intercanthal distance should be optimized in early definitive reconstruction, as delayed revision is particularly challenging.”
Quote in the paperNot a substantial claimClassified as probably not a substantial claim.
PremisecitationMassive facial trauma can be understood as a facial injury, more often due to ballistic or avulsive forces, that results in significant soft tissue and bone loss necessitating substitution of missing components through surgical practices.
“Although not technically defined, massive facial trauma can be understood as a facial injury, more often due to ballistic or avulsive forces, that result in significant softtissue and bone loss necessitating substitution of missing components through a variety of surgical practices [2] .”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [2]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
May combine two claims.
PremisecitationVPS-guided fibula reconstruction decreased complications, with fewer flap losses and fistula.
“There was a significant decrease in nonunion rate (20% vs. 4%) and complications, with fewer flap losses and fistula.”
Quote in the paperSubstantial claim0 of 1 sources checked- cites [39]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
Probably not a substantial claim: may not pass S3 (load-bearing).
PremisecitationThe collective aesthetic relationships and contours of the eyes, nose, and lips are central to facial recognition.
“This area is also critical to the foundation and perception of personal identity, as the collective aesthetic relationships and contours of the eyes, nose, and lips are central to facial recognition [10] .”
Quote in the paperNot a substantial claim0 of 1 sources checked- cites [10]
Couldn’t be matched to a paper in Crossref, so it can’t be checked.
The paper relies on this without support.
Ballistic injuries to the face are much more likely to produce injuries classifiable as massive facial trauma.
“Ballistic injuries to the face are much more likely to produce injuries classifiable as massive facial trauma, and the United States continues to suffer from an epidemic of gun violence, as evidenced by the roughly eight times higher death rate due to firearms than other high-income nations [5,6] .”
The paper relies on this without support.
There is a paucity of large-scale studies regarding the epidemiology and treatment of massive facial trauma patients.
“There is a paucity of large-scale studies regarding the epidemiology and treatment of massive facial trauma patients; however, inferences can be made by combining related trends in the literature with anecdotal and institutional experience.”
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
Conflicting ages for the patient in Figure 3
MinorThe text describes the patient in Figure 3 as 19 years old, while the Figure 3 caption describes the patient at the initial encounter as 23 years old.
“Figure 3 illustrates successive procedures in a 19-year-old male who sustained a self-inflicted shotgun wound [Figure 3A]”
“(A) A 23-year-old male who sustained a self-inflicted gunshot wound to the face, initial encounter;”
Cites
THE FREE VASCULARIZED BONE GRAFT
Taylor, G. I., MILLER, G. D. H., & HAM, F. J. (1975) · Plastic & Reconstructive Surgery · doi:10.1097/00006534-197505000-00002 · Cited by 1,537 · see citing works
Fibula Osteoseptocutaneous Flap for Reconstruction of Composite Mandibular Defects
Wei, F., Seah, C.-S., Tsai, Y.-C., Liu, S.-J., & Tsai, M.-S. (1994) · Plastic & Reconstructive Surgery · doi:10.1097/00006534-199402000-00009 · Cited by 403 · see citing works
Epidemiology of Facial Fracture Injuries
Allareddy, V., Allareddy, V., & Nalliah, R. P. (2011) · Journal of Oral and Maxillofacial Surgery · doi:10.1016/j.joms.2011.02.057 · Cited by 319 · see citing works
Epidemiologic trends in fatal and nonfatal firearm injuries in the US, 2009-2017.
Kaufman, E. J., Wiebe, D. J., Xiong, R. A., Morrison, C. N., Seamon, M. J., & Delgado, M. K. (2021) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2020.6696 · Cited by 285 · see citing works
Nasal Reconstruction???Beyond Aesthetic Subunits: A 15-Year Review of 1334 Cases
Rohrich, R. J., Griffin, J. R., Ansari, M., Beran, S. J., & Potter, J. K. (2004) · Plastic & Reconstructive Surgery · doi:10.1097/01.prs.0000138596.57393.05 · Cited by 253 · see citing works
Reconstruction of the Lower Lip and Chin with the Composite Radial Forearm—Palmaris Longus Free Flap
Sadove, R. C., Luce, E. A., & McGrath, P. C. (1991) · Plastic & Reconstructive Surgery · doi:10.1097/00006534-199108000-00005 · Cited by 157 · see citing works
Clark, N., Birely, B. C., Manson, P. N., Slezak, S. S., Kolk, C. A. V., Robertson, B., & Crawley, W. A. (1996) · Plastic & Reconstructive Surgery · doi:10.1097/00006534-199609001-00001 · Cited by 146 · see citing works
Computer-Assisted versus Conventional Free Fibula Flap Technique for Craniofacial Reconstruction
Seruya, M., Fisher, M. C., & Rodriguez, E. D. (2013) · Plastic & Reconstructive Surgery · doi:10.1097/prs.0b013e3182a3c0b1 · Cited by 143 · see citing works
Biller, H. F., Baek, S.-M., Lawson, W. L., Krespi, Y. P., & Blaugrund, S. M. (1981) · Archives of Otolaryngology - Head and Neck Surgery · doi:10.1001/archotol.1981.00790370025004 · Cited by 101 · see citing works
Firearm Injury in the United States: An Overview of an Evolving Public Health Problem
Tasigiorgos, S., Economopoulos, K. P., Winfield, R. D., & Sakran, J. V. (2015) · Journal of the American College of Surgeons · doi:10.1016/j.jamcollsurg.2015.08.430 · Cited by 83 · see citing works
Lip and Perioral Reconstruction
Langstein, H. N., & Robb, G. L. (2005) · Clinics in Plastic Surgery · doi:10.1016/j.cps.2005.02.007 · Cited by 82 · see citing works
Menick, F. J., & Salibian, A. H. (2011) · Plastic & Reconstructive Surgery · doi:10.1097/prs.0b013e3181fed686 · Cited by 82 · see citing works
Changing Trends in Adult Facial Trauma Epidemiology
VandeGriend, Z. P., Hashemi, A., & Shkoukani, M. A. (2015) · Journal of Craniofacial Surgery · doi:10.1097/scs.0000000000001299 · Cited by 75 · see citing works
Rodriguez, E. D., Martin, M., Bluebond‐Langner, R., Khalifeh, M., Singh, N., & Manson, P. N. (2007) · Plastic & Reconstructive Surgery · doi:10.1097/01.prs.0000260728.60178.de · Cited by 72 · see citing works
May, M. M., Howe, B. M., O'Byrne, T. J., Alexander, A. E., Morris, J. M., Moore, E. J., Kasperbauer, J. L., Janus, J. R., Abel, K. M. V., Dickens, H. J., et al. (2021) · Head & Neck · doi:10.1002/hed.26688 · Cited by 72 · see citing works
Definitive management of severe facial trauma utilizing free tissue transfer
Futran, N. D., Farwell, D. G., Smith, R. B., Johnson, P. E., & Funk, G. F. (2005) · Otolaryngology · doi:10.1016/j.otohns.2004.08.013 · Cited by 69 · see citing works
Self-citationFree-Tissue Transfer Reconstruction of Midfacial and Cranio-orbito-facial Defects
Funk, G. F., Laurenzo, J. F., Valentino, J. P., McCulloch, T. M., Frodel, J. L., & Hoffman, H. T. (1995) · Archives of Otolaryngology - Head and Neck Surgery · doi:10.1001/archotol.1995.01890030033006 · Cited by 68 · see citing works
Roden, K. S., Tong, W. W. Y., Surrusco, M., Shockley, W. W., van Aalst, J. A., & Hultman, C. S. (2012) · Annals of Plastic Surgery · doi:10.1097/sap.0b013e31823b69dd · Cited by 67 · see citing works
First human facial retransplantation: 30-month follow-up
Lantieri, L. A., Cholley, B., Lemogne, C., Guillemain, R., Ortonne, N., Grimbert, P., Thervet, É., & Lellouch, A. G. (2020) · The Lancet · doi:10.1016/s0140-6736(20)32438-7 · Cited by 59 · see citing works
US Firearm-Related Mortality: National, State, And Population Trends, 1999–2017
Goldstick, J. E., Zeoli, A., Mair, C., & Cunningham, R. M. (2019) · Health Affairs · doi:10.1377/hlthaff.2019.00258 · Cited by 53 · see citing works
Vascularised bone transfer: History, blood supply and contemporary problems
Sparks, D. S., Saleh, D. B., Rozen, W. M., Hutmacher, D. W., Schuetz, M., & Wagels, M. (2016) · Journal of Plastic Reconstructive & Aesthetic Surgery · doi:10.1016/j.bjps.2016.07.012 · Cited by 43 · see citing works
Vascularized composite allotransplantation - a Council of Europe position paper
Thuong, M., Petruzzo, P., Landín, L., Mahíllo, B., Kay, S. P., Testelin, S., Jabłecki, J., Laouabdia-Sellami, K., López‐Fraga, M., & Domínguez‐Gil, B. (2018) · Transplant International · doi:10.1111/tri.13370 · Cited by 40 · see citing works
Gürünlüoğlu, R., Glasgow, M., Williams, S. A., Gurunluoglu, A., Antrobus, J., & Eusterman, V. D. (2012) · Journal of Plastic Reconstructive & Aesthetic Surgery · doi:10.1016/j.bjps.2012.04.039 · Cited by 38 · see citing works
Extended Karapandzic Flaps for Near-Total and Total Lower Lip Defects
Hanasono, M. M., & Langstein, H. N. (2011) · Plastic & Reconstructive Surgery · doi:10.1097/prs.0b013e318205f3ce · Cited by 38 · see citing works
A Virtual Surgical Planning Algorithm for Delayed Maxillomandibular Reconstruction
Stranix, J. T., Stern, C. S., Rensberger, M., Ganly, I., Boyle, J. O., Allen, R. J., Disa, J. J., Mehrara, B. J., Garfein, E. S., & Matros, E. (2019) · Plastic & Reconstructive Surgery · doi:10.1097/prs.0000000000005452 · Cited by 38 · see citing works
Contemporary reconstruction after complex facial trauma
Zeiderman, M. R., & Pu, L. L. Q. (2020) · Burns & Trauma · doi:10.1093/burnst/tkaa003 · Cited by 38 · see citing works
Cuéllar, C. N., Martínez, E. B., Cuéllar, I. N., López, A. M. L., Tousidonis, M., Sánchez‐Pérez, A., & Escobar, J. I. S. (2020) · Journal of Oral and Maxillofacial Surgery · doi:10.1016/j.joms.2020.08.003 · Cited by 30 · see citing works
Algorithm for nasal reconstruction
Manson, P. N., Hoopes, J. E., Chambers, R. G., & Jaques, D. A. (1979) · The American Journal of Surgery · doi:10.1016/0002-9610(79)90413-6 · Cited by 29 · see citing works
Naso-Orbital-Ethmoid Complex Fracture Management
Hoffmann, J. F. (1998) · Facial Plastic Surgery · doi:10.1055/s-0028-1085303 · Cited by 26 · see citing works
Gürünlüoğlu, R., & Gatherwright, J. R. (2019) · Microsurgery · doi:10.1002/micr.30418 · Cited by 26 · see citing works
Medial canthopexy of old unrepaired naso-orbito-ethmoidal (noe) traumatic telecanthus
Elbarbary, A. S., & Ali, A. (2013) · Journal of Cranio-Maxillofacial Surgery · doi:10.1016/j.jcms.2013.03.003 · Cited by 25 · see citing works
Mehra, P., Caiazzo, A., & Bestgen, S. C. (1998) · Journal of Oral and Maxillofacial Surgery · doi:10.1016/s0278-2391(98)90771-6 · Cited by 22 · see citing works
The Split Orbicularis Myomucosal Flap for Lower Lip Reconstruction
Ducic, Y., Athre, R., & Cochran, C. S. (2005) · Archives of Facial Plastic Surgery · doi:10.1001/archfaci.7.5.347 · Cited by 22 · see citing works
An Algorithmic Approach to the Management of Ballistic Facial Trauma in the Civilian Population
Chattha, A. S., Lee, J. C., Johnson, P. K., & Patel, A. (2018) · Journal of Craniofacial Surgery · doi:10.1097/scs.0000000000004741 · Cited by 19 · see citing works
A refined technique for oral commissurotomy
Berlet, A. C., Ablaza, V. J., & Servidio, P. (1993) · Journal of Oral and Maxillofacial Surgery · doi:10.1016/s0278-2391(10)80151-x · Cited by 17 · see citing works
Face Transplantation: An Update for the United States Trauma System
Farber, S. J., Kantar, R. S., Diaz-Siso, J. R., & Rodriguez, E. D. (2018) · Journal of Craniofacial Surgery · doi:10.1097/scs.0000000000004615 · Cited by 17 · see citing works
Facial Transplantation for Massive Traumatic Injuries
Alam, D. S., & Chi, J. J. (2013) · Otolaryngologic Clinics of North America · doi:10.1016/j.otc.2013.06.001 · Cited by 16 · see citing works
Late sequelae after high midface trauma.
Kalavrezos, N., Graetz, K. W., Eyrich, G., & Sailer, H. F. (2000) · PubMed · Cited by 11 · see citing works
A Call to Action: Firearms, Public Health, and Emergency Medicine
Ranney, M. L., Sankoff, J. D., Newman, D. H., Fenton, A. H., Mukau, L., Durston, W. E., Ballard, D. W., & Wintemute, G. J. (2013) · Annals of Emergency Medicine · doi:10.1016/j.annemergmed.2013.02.015 · Cited by 10 · see citing works
Eser, C., Gencel, E., Kesiktaş, E., & Yavuz, M. (2016) · Journal of Craniofacial Surgery · doi:10.1097/scs.0000000000002688 · Cited by 9 · see citing works
Management of Facial Trauma: Lessons of War
McDonald, T. J., & López, M. (2010) · Facial Plastic Surgery · doi:10.1055/s-0030-1267722 · Cited by 8 · see citing works
Krane, N. A., Fagin, A. P., Ghanem, T., Cannady, S. B., Petrisor, D., & Wax, M. K. (2020) · Microsurgery · doi:10.1002/micr.30652 · Cited by 7 · see citing works
Role of Free Tissue Transfer in Facial Trauma
Kim, R. Y., Sokoya, M., Williams, F. C., Shokri, T., & Ducic, Y. (2019) · Facial Plastic Surgery · doi:10.1055/s-0039-1700880 · Cited by 3 · see citing works
Horen, S. R., Lopez, J., & Dorafshar, A. H. (2021) · Facial Plastic Surgery · doi:10.1055/s-0041-1723766 · Cited by 3 · see citing works
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Mass Casualties, Shootings, and the Role of the Craniomaxillofacial Surgeon
Mohan, V. C., Gillipelli, S. R., Schmidt, J. L., Bovill, J. D., & Latham, K. P. (2025) · Seminars in Plastic Surgery · doi:10.1055/s-0044-1801408 · Cited by 1 · see citing works
- Authors
- Pang, J., Cash, H., & Futran, N.
- Affiliations
- University of Washington (US)
- Corresponding author
- Futran, Neal
- Venue
- Plastic and Aesthetic Research
- Publisher
- OAE Publishing Inc.
- Published
- 2022
- Volume
- 8
- Issue
- 8
- Pages
- 49
- ISSN
- 2347-9264 (ISSN-L)
- 2349-6150
- OpenAlex
- W3204380231
- Cited by
- 1
- References
- 45
- Citations by year
- 2025: 1
- FWCI
- 0.24
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Licence
- cc-by
- Locations
- Plastic and Aesthetic Research (publishedVersion, cc-by)
- Topics
- Health Sciences › Medicine › Surgery › Reconstructive Surgery and Microvascular Techniques
- Health Sciences › Medicine › Surgery › Reconstructive Facial Surgery Techniques
- Health Sciences › Medicine › Surgery › Facial Trauma and Fracture Management
- Keywords
- free flap, facial trauma, radial forearm free flap, fibula free flap, latissimus dorsi flap, telecanthus, nasal defects, microstomia, virtual surgical planning, face transplantation, functional and aesthetic outcomes, sinonasal reconstruction
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Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
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