Higher Complication Rates in Self-Inflicted Gunshot Wounds After Microvascular Free Tissue Transfer

Objectives/Hypothesis: Microvascular free tissue transfer is often employed to reconstruct significant facial defects from ballistic injuries. Herein, we present our comparison of complications between self-inflicted and non–self-inflicted gunshot wounds after microvascular free tissue transfer. Study Design: Retrospective case review. Methods: Approval was obtained from the JPS institutional review board. We performed a retrospective review of cases of ballistic facial injuries between October 1997 and September 2017 that underwent vascularized free tissue transfer for reconstruction. Comparisons were made between self-inflicted and non–self-inflicted gunshot wounds after microvascular free tissue transfer. The χ ² test was used for all comparisons. P value and 95% confidence interval (CI) were reported. Results: There were 73 patients requiring free flap reconstruction after gunshot wounds to the face during the study period. There was a statistically significant difference in the rates of nonunion between self-inflicted and non–self-inflicted wounds (P =.02, 95% CI: 0.9 to 35.8) There were also no significant differences in flap failure (P =.10, 95% CI: −2.8 to 24.2), plate exposure (P =.28, 95% CI: −6.7 to 33.0), wound infection (P =.40, 95% CI: −8.9 to 31.2), scar contracture (P =.60, 95% CI: −8.1 to 25.1), and fistula formation (P =.13, 95% CI: −2.8 to 28.8) between patients with self-inflicted and those with non–self-inflicted wounds. Overall, complication rates were significantly higher in the self-inflicted group compared to the non–self-inflicted group (P <.0001, 95% CI: 32.6 to 68.6). Conclusions: Patients with self-inflicted injuries had more complications postoperatively than those with non–self-inflicted injuries. This is likely helpful in surgical planning and patient counseling. Level of Evidence: 4 Laryngoscope, 129:837–840, 2019.