A patient, aged 25 years and a construction worker, accidentally fell on a granite cutter severing his nose and lip area. He arrived at our hospital with profuse bleeding & a disfigured face and was admitted to the intensive care unit. The upper teeth were exposed and the oral mucosa was dry and painful. Nutrition and Speech were difficult and painful for the patient.
The best course of treatment was to perform a lip and nose revision to restore back the anatomy of the face in the most aesthetic way possible. The patient was counselled on the treatment procedure and outcome so that he could cope with the temporarily protracted treatment and not give in to social and psychological stress.
Nasal reconstruction occupies a special position in facial plastic surgery because of the complex three-dimensional surfaces of the nose, the varying thickness of the skin covering it, and various types of scaffolding ranging from rigid bone to flexible cartilage and its inner epithelial lining. The facial tissues are unique in shape, texture, and colour. A particularly unique feature in its anatomy is the close association of the skin with underlying muscle architecture, comprising of the unique combination of function, facial expression, and aesthetics.
The patient was first administered lidocaine with adrenalin/epinephrine 1:100,000 local infiltration for pain control as well as for wound edge vasoconstriction which facilitates visualization. This was followed by the administration of general anaesthesia, cleaning of the wound, and careful assessment before approximating wound edges. Traumatic flaps were rotated back to their original position, just like fitting the pieces of a puzzle together. Wounds were carefully sutured in layers with care to close muscle fascia, deep dermis, and epidermis. Wound edges that were bevelled, as well as the devitalized tissue, were appropriately debrided.
The patient responded to the treatment well. Once the swelling subsided, the patient started with minimal functional movements.
He was discharged after 2 days of observation. He was very happy and thankful to the doctors since the procedure helped him regain the functionality and aesthetics of his face.