Journal of Neurology and Experimental Neural Science (ISSN: 2577-1442)

Article / research article

"Minimal Traumatic Skin Traction in Facial Severe Injury vs. Conventional Rotation Flap "

Consultant Neurosurgeon, Al-Sadir Medical City, Najaf, Iraq

 *Corresponding author: Abbas Alnaji, Al-Sadir Medical City, Najaf, Iraq. Tel: +964 7700059052; E-mail: abbasalnaji@yahoo.com

 Received Date: 27 April, 2017; Accepted Date: 05 May, 2017; Published Date: 15 May, 2017

Neurosurgeon deals with the head injuries. But it happens he may deal with facial injuries. A case of huge ugly facial wound caused by a nearby high velocity tangential pistol bullet to form a four fingers width facial skin loss with nose distortion. An initial stage of surgical under mining done but due to big loss under-miming was not the practical solution. Also, conventional rotation flap is not an artful choice for such cases due to the uniqueness of texture of each very small piece of area of the face for that an alternative way was adopted to close the defect more intelligently and more artfully. It is multi stage skin traction to preserve the linearity of skin touch by very delicate and technically programmed minimal skin traction with wound protection along the period of closure.

Keywords: Biological Surgery; Facial Injury; Head Injury; Natural or Inherited Stored Memory of Patient Facial Mode; Rotation Flap; Skin Traction; Tissue Fluidity

  1. Introduction

Neurosurgeon deals with the head injuries. But it happens he may deal with facial injuries. In skin losses happen anywhere in the body a conventional rotation flap is done to cover the bare area whether small or big. In facial skin loss, these rotation flaps are not an artful choice for such cases due to the uniqueness of each very small piece of area of the face, so bringing a piece of skin from any part of face to be put in the defect by rotation flap will end in a discrimination in skin architecture between the brought one and the adjacent original skin as well “The natural stored or inherited memory of patient facial mode”. For that an alternative way is adopted to close the defect more intelligently and more artfully. It preserves the linearity of skin touch by very delicate and technically programmed minimal traction with wound protection along the period of closure. A case of huge ugly facial wound caused by a nearby high velocity tangential pistol bullet to form a four fingers width of facial skin loss with nose distortion.  An initial stage of surgical under mining resulted in a width of wound as seen in (Figure1). Also, to show the role of concepts other than the hand surgical skills like “Biological Surgery” and “Tissue Fluidity” in dealing with or management of acquired or congenital surgical cases.

2. Material and Methods

 A 35 years old male subjected to attack to result in huge ugly facial wound caused by a nearby high velocity tangential pistol bullet to form a four fingers width facial skin loss with nose distortion., they are directed to comply the geometry of the facial design. Gradual margins traction in steps and direction wise to cover the raw wound bed of daily or every other day sittings of traction re-setting. Comfeel paste was used to protect the raw area along treatment interval. Traction done with different means ranges from 5 zero sutures with a cutting or round needles according to the anchored edge's nature. Or acrylic adhesive with a wide skin front away from wound edge. In either traction force or tension controlled by rubber band of suitable sizes. No antibiotics are given neither local nor systemic apart from 300 mg of ascorbic acid is given orally, daily. Other facial hygiene or cleanliness is done by diluted spirit soaked soft tissues done by me as surgeon to the margins of the wound as anti-debris, anti-infective and anti-grease to enable adhesive to adhere to skin, patient takes care of the area around the covered wound along the day, accordingly.

3. Results

Over 4 weeks’ course of treatment the wound edges and the contour of the defect are very happily responding. Serial pictures can show the chronological steps of wound healing. No skin lacerations or cellulites’ happened all the time of treatment. Very soft encouraging positive events that made me proceed in a first-time case and technique. 

4. Discussion

Skin, this is the mysterious organ. It is full of surprises; it is a good tool and target in the hands of the artful surgeons. It shows the magic capacity when it explored. It is as any other structure in the body, it obeys the rule of “Biological Surgery” where a big job or gain is obtained by minimal surgical act when we understand and utilize the natural or the biological capacities of the body. In Nature, there are cascade of processes triggered by a single event, this trigger may be very minute in face of the successive operations that change a greater system. Biology is part of the Nature, so the same will be applied. As our bodies are biological systems, we can make good use of this fact by looking for the keys in our bodies where they switch on or open the treasures within our body. Changing pH in the cell will direct a chain of chemical reactions in certain path to produce a given substance X which in its turn enter in to accomplish a certain function. As this is well known in primary medical teaching about cell function from within. Also, it is known that changing cell from without (external environment) make or triggers changes in the cell and hence our body. By passing backward, from the cell as our body is a sum of them towards the function of the cell in its sum variety (tissue) and the sum variety of these tissues (organ). This triple cell, tissue and organ architectural system has its internal to and through interchangeable or dynamic fluidity (I think we had better to term it as “Tissue Fluidity”), if further known about. It will be the same as we knew about the Atom, its substructures, interatomic behavior represented by Plasma and the well-known fictionalization’s of them in modern scientific applications by atomic physics or industry.

If we come back to biology, the above is a general philosophy or idea which may discuss the theory of “contact inhibition” in embryology, where approaching tissues stop their march when reach each other like what happens in neuronal tube closure to form vertebral column and spinal cord and the defects as myelomeningoceles that results from “non-contact” (review the huge myelomeningocele repair by skin traction by the same author). There is a natural process that brought three embryological layers Ectoderm, mesoderm and endoderm all together to form the body form. In routine or traditional surgery, we try to correct structural abnormalities whether inherited or acquired mostly by skilled hand maneuvers, it lacks or it is of least attention to this Tissue Fluidity, which is a mode of wider concept the “Biological surgery”. Simply, in this case of facial injury we had brought skin, fascia, muscles and nerves to acceptable approximate not from esthetic point of view only but majorly from this “Tissue Fluidity’’ idea exactly like what happened in the huge myelomeningocele repaired by programmed skin traction for the same author.

Another vital concept which is the “natural stored or inherited memory of patient facial mode”. This is as the person identity is in finger print or iris coding. We find these days some cameras a watching ones can pick up the wanted personals from a distance. This is based on the facial print. So, bringing a patch from area to be put in another will distort the biologic construction on which this system works. Of course, the aspect of it is not confined for camera detection. No, it is basically for the person himself and his related persons when react with each other’s. While approximation will minimize the ill-effect.

5. Conclusion

It is very safe way to reconstruct such vital and delicate tissue where every tiny area of it has its unique texture. Making rotation flaps disfigure face. Scar can be easily disappearing by re-excision and aesthetic sutured or adhesive.

Recommendations

I recommend wider cooperation in this regard by interested surgeons for better concepts

Figure 1: Showing the Bare Area Left after Surgical Under-Mining.

Figure 2: Three Days after Start of Skin Traction, Difference in Wound Width is Noticeable, Marks of Adhesive Band Places and the Sharp Small Wounds in the Defect Edges are clear.

 

Figure 4: One Week after the Previous Picture to Show More Narrowing in Nose and the Check Wound Edges are Submerged. (Figure 3: is skipped due to minimal changes).

Figure 4: One Week after the Previous Picture to Show More Narrowing in Nose and the Check Wound Edges are Submerged. (Figure 3: is skipped due to minimal changes).

Figure7: Re-Canalization of the Nose. Some Left Upper Lip Distortion.

Figure 8: Granulation Tissue Nearly to Disappear.

 


 

Figure 9: No Granulation Tissue. Nose Fully Open. Patient Now Put a Small Strip of Adhesive Band as Walking in Streets.


 

Figure 10: The Scar is so small that Very Simple Plastic Wounding is Capable of vanishing it with Ala Reconstruction.

 

 

 


By reviewing the standard textbooks and the literatures, no reference in this meaning of a reference to be mentioned. It is well known what should plastic and aesthetic surgeons do. But not this way of programmed traction.

Citation: Alnaji A (2017) Minimal Traumatic Skin Traction in Facial Severe Injury vs. Conventional Rotation Flap “The Esthetic Concept”. J Neurol Exp Neural Sci 2017: JNENS-128. DOI: 10.29011/JNNS-128. 100028

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