High-energy ballistic and avulsive facial injuries: Classification, patterns, and an algorithm for primary reconstruction

Norman Clark, Brent Birely, Paul N. Manson, Sheri Slezak, Craig Vander Kolk, Bradley Robertson, William Crawley

Research output: Contribution to journalArticlepeer-review

82 Scopus citations


A 17-year experience from 1977 to 1993 with gunshot, shotgun, and high- energy avulsive facial injuries emphasizes rite superiority and safety of 'ballistic wound' surgical management: (1) immediate stabilization in anatomic position existing bone, (2) primary closure of existing soft tissue, (3)periodic 'second look' serial debridement procedures, an d (4) definitive early reconstruction of softtissue and bony defects. The series contains 250 gunshot wounds, 53 close-range shotgun wounds and 15 highenergy avulsive facial injuries. Four general patterns of involvement are noted for both gunshot and shotgun wounds and three for avulsive facial injuries. The treatment algorithm begins with identifying zones of injury and loss for both soft and hard tissue. Gunshot wounds are best classified by the location of the exit wound; shotgun and avulsive facial wounds are classified according to the zone of sott-tissue and bone loss. Treatment, prognosis, and complications vary according to four patterns of gunshot wounds and four patterns of shotgun wounds. Avulsive wounds have not been recommended previously for ballistic wound surgical management. The appropriate management of high-energy avulsive and ballistic facial injuries is best approached by an aggressive treatment program emphasizing initial primary repair of existing tissue, serial conservative debridement, and early definitive reconstruction.

Original languageEnglish (US)
Pages (from-to)583-601
Number of pages19
JournalPlastic and reconstructive surgery
Issue number4
StatePublished - Sep 1996
Externally publishedYes

ASJC Scopus subject areas

  • Surgery


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