Lip and Nose Reconstruction following trauma
Patient named Kumar, aged 25 years, a construction worker, accidentally fell on a granite cutter severing his nose and lip area. He landed with profuse bleeding and a disfigured face. He was admitted to intensive care unit. The upper teeth were exposed and the oral mucosa was dry and painful. Nutrition and Speech were difficult and painful to the patient.
Patient needed a lip and nose revision to restore back the anatomy of the face in the most aesthetic way possible. Nasal reconstruction occupies a special position in facial plastic surgery because of the complex three dimensional surface 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 unique combination of function, facial expression and aesthetics.
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.
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. Then general anaesthesia was administered. The wound was cleaned and carefully assessed before approximating wound edges. Traumatic flaps were rotated back to their original position very much 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 and devitalized tissue were appropriately debrided.
The patient coped with the procedure well. The swelling gradually subsided and he started with minimal functional movements. He was discharged after 2 days of observation. The patient was very happy and thankful to the doctors since the procedure helped him regain the functionality and aesthetics.