The types of soft-tissue injuries encountered include abrasions, tattoos, simple or complex contused lacerations with loss of tissue, avulsions, bites and burns. Common etiological factors include road traffic accidents, gunshot injuries, blast injuries, foreign bodies, homicidal trauma, thermal, chemical and electrical burn, suicidal injuries, human bites, animal bites or caused by different animals etc. Facial soft tissue injuries vary in severity based on the impact force and type of injury into minor superficial wounds to massive avulsions. Disfigurement following trauma, becomes a social stigma and has the gross detrimental effect on the social we being of the patient. Therefore, such cases are most appropriately managed by a reconstructive surgeon who has a thorough knowledge of applied anatomy, an aesthetic sense and meticulous atraumatic tissue handling expertise, coupled with surgical skill to repair all the composite structures simultaneously. Most defects can be reconstructed immediately leading to better restoration of form and function with early rehabilitation. Commonly there is a wide range of options for repairing a given defect. These include healing by secondary intention, primary closure, placement of a skin graft, mobilization of local or regional flaps, and free flaps. Local flaps often produce superior functional and esthetic results. A great advantage of local flaps is that the tissue compares closely to the missing skin in color and texture. These flaps can be rotated, advanced, transposed, or interpolated into the tissue defects.
Necrosis of the soft tissue is one of the major complication encountered with deep or massive soft tissue injury. Since orofacial region has rich vascular supply from branches of the facial artery, the end result of treatment is most often positive. Blunt trauma may result in extensive and prolonged tissue damage with subsequent deep scarring and poor esthetics. Electrocautery should be used in its lowest setting, conducive to coagulation. Delays in treatment can result in increased soft tissue swelling, obscuring landmarks and making primary closure more difficult. Increased soft tissue wound exposure is associated with an increased risk of infection. Ideally, closure should occur within the first 8 hours after injury. Broad-spectrum antibiotic coverage is necessary in bite wounds and in patients with impaired wound healing due to smoking, alcoholism, diabetes, or other forms of immune compromise. Tetanus prophylaxis should be given according to the patient’s immunization history. Individuals with darker skin pigmentation may be prone to excessive scarring (keloids) and pigmentation changes. If scarring appears to extend beyond the wound margins, a keloid scar may be forming. Topical hydrocortisone, injectable triamcinolone and even low-dose radiation may be helpful in reducing keloid scars. Finally, scars that are discoloured can be tattooed with permanent medical grade pigment to match the surrounding skin. Revision of scars should be deferred until final maturation is complete which is approximately 6–12 months postinjury.