The Management of gunshot injury to the mandible and facial soft-tissues with a free osteomyocutaneous dciap flap: a case report

Abstract

Aim: The osteomyocutaneous deep circumflex iliac artery perforator (DCIAP) flap provides a large well-vascularized segment of bone suitable for reconstruction of the extremities and mandible. We aimed to share our experience in using this flap for reconstruction of gunshot injury to the mandible and facial soft-tissues. Method: A 46-year-old male patient presented to the emergency department with a facial gunshot wound of size 10x10 cm. Injuries included open comminuted fracture of the body and left ramus of mandible, fractures of left alveolar and palatine processes of the maxilla, left zygomatic arch, left orbital bones as well as defects to the soft-tissues of left lowercentral face and upper part of neck. After stabilization of vital functions, a first surgery which aimed to achieve fixation of unstable facial bones was performed. A large 4x6 cm defect of mandible remained after the surgery. Three weeks after the first intervention a second surgery was carried out. The free osteomyocutaneous DCIAP flap was chosen to reconstruct the defect of mandible and soft-tissues. The flap was obtained from the right groin region. A 6x9 cm skin paddle together with full thickness iliac crest and adherent internal oblique muscle was raised and inset to the injury site, then fixed with a reconstruction plate. Results / Discussion: The postoperative period was uneventful. The flap remained viable at two-month follow-up, with no skin necrosis or flap breakdown. Conclusion: Our experience in the presented case as well as similar previous cases confirm that free osteomyocutaneous DCIAP flap is a highly suitable option for mandibular and facial soft-tissue reconstruction as it provides large high-quality bone integration due to the suitable parameters and mass of the bone as well as appropriate vessel diameter for microsurgical application.