The face, owing to its prime position in the human body is the first most visible part so adequate attention should be paid during reconstruction of such patients. Severe facial trauma often involves multiple aesthetic units of the face [3] Every attempt should be made to achieve near perfect results, and the reconstructive process should aim to provide acceptable functional and aesthetic outcomes [4]. Soft tissue injuries of the face are commonly encountered by providers caring for trauma patients with lacerations of the face and scalp accounting for 50% of the wounds treated in the emergency department [5]. These injuries can be isolated to the soft tissues or be associated with cranio- facial fractures. Regardless of the injury, facial soft tissue injuries require careful assessment and management to ensure optimal aesthetic and functional outcomes [6]. Facial reconstruction methods vary from primary closure to local, distant or free flaps depending on several factors: size of defect, location of face and the conditions of adjacent tissue. This study is aim at looking at the result of various methods of reconstruction soft tissue defect of the face with respect to function and aesthetic outcomes.

This study is done in the Department of Burn & Plastic Surgery, Gandhi Medical College, Bhopal in total 104 patients admitted with the diagnosis of soft tissue defect of face due to various etiology like- • Trauma (Road traffic accident, Burn, Assault) • Post-Surgical Procedure for Tumour (Malignant & non-malignant) All these cases are included in our study and all patients who are not fit for surgery due to life threatening conditions, head injury patients with unconsciousness, patients with facial bone fractures are excluded from study. After informed written consent; A detailed history has taken and through physical examination have done. On the basis of defect type of operative procedure was performed including primary closure, secondary closure, skin grafting, flaps (local, regional and free flap) and then patient were followed up in OPD and were evaluated with respect to functional and aesthetic outcomes of various methods.

Table no. 1. Distribution of patients according to age group Age group Number of patients 0–10 Years 14 11–20 Years 10 21–30 Years 28 31–40 Years 18 41–50 Years 14 51–60 Years 08 61–70 Years 12 In our study, out of 104 patients, 70 were male and 34 were female. Most of the patients (n=28) were in the 21–30 years age group, followed by 31–40 years (n=18) and 41–50 years (n=14). Table no. 2. Distribution of patients according to etiology Mode of injury Number of patients Assault 16 RTA 48 Post-surgical excision 20 Burn 6 Human bite 8 Dog bite 6 The most common etiological factor for soft-tissue defects of the face was road traffic accidents (n=48), followed by post-surgical excision (n=20), in which the most common cause was malignancy (n=12), and then assault (n=16). Table no. 3. Distribution of patients according to involvement of facial units Unit of face involved Number of patients Forehead 12 Cheek 30 Nose 06 Eyelids 10 Lips 14 Chin 00 Ear 02 Multiple (adjacent) units 30 According to involvement of facial subunits, the most commonly affected units were the cheek and multiple adjacent units (each n=30), followed by lips (n=14), forehead (n=12), eyelids (n=10), nose (n=6), and ear (n=2). Among patients with involvement of multiple adjacent units, two units were involved most commonly (n=18), followed by three units (n=10). Table no. 4. Distribution of patients according to reconstruction method Treatment method Number of patients Flap 52 Grafting 12 Primary repair 36 Secondary suturing 04 Flap coverage (n=52) was the most common treatment method in our study, followed by primary repair of the wound (n=36), skin grafting (n=12), and secondary suturing (n=4). Table no. 5. Distribution of patients according to flap Type of flap Number of patients Mustarde flap 11 Nasolabial flap 13 V-Y advancement flap 09 Random pattern flap 19 In flap reconstruction, the most commonly performed flap was the random pattern flap (n=19), followed by the nasolabial flap (n=13), Mustarde flap (n=11), and V-Y advancement flap (n=9). Table no. 6. Assessment of functional status of patients after reconstruction Functional status No. of patients Good 96 Acceptable 08 Functional status was good in 92% of patients (n=96) and acceptable in 8% (n=8). In terms of aesthetic outcome, color match and texture of the reconstructed tissue were good in 82 patients and acceptable in 22 patients.

In our study out of 104 patients 34 are female and 70 are male. Most of the patients(n=28) are in 21-30 years of age, next common affected age group is between 31-40 years of age (n=18) and least common age group is 51-60 years (n=8). This is similar to other studies and study done by S. Anuradha et al. (6) in 90 patients, 71% (n=64) patients were males and 29% (n=26) were females. 51% (n = 46) patients belonged to 21-40 years of age, 37% (n=33) patients belonged to 41-60 years of age. Most common etiological factor in our study is road traffic accidents (n=48) followed by postsurgical excision (n-20) [in which most common cause is malignancy(n=12)], assault (n=16). Similar findings are observed in study done by Spurthi S. et al. (7) in 50 patients, road traffic accidents were the leading cause of injury in 28 (56%) cases, followed by falls (11, 22%), occupational injuries (6, 12%) and assault (5, 10%). In our study according to involvement of facial subunits, cheek and multiple units of face (each n=30) are most commonly affected unit followed by lips(n=14), forehead(n=12), eyelids(n=10), nose (n=6) and ear(n=2). Flap coverage (n=52) is most common treatment method, followed by primary repair of wound (n=36) and skin grafting (n=12) in our study. These findings are similar to study done by Mehvash Khan et al (8) for acquired soft tissue defects of face in which most common site of defect was cheek (35%) followed by nose (30%). Flaps were the most common modality of coverage (52.5%) followed skin grafting (22.5%) and primary closure of the wound done in 25% of the cases. None of the patient in our study had any major complications after surgery except ectropion of lower eyelid in 4 patients for which correction is required. In our study Functional status was good in 92% of patients(n=96) with primary repair of wound or flap coverage and acceptable functional status was seen only in 8% (n=8). 82 patients had good aesthetic outcomes with good colour and texture match who underwent either primary repair of wound or flap coverage and acceptable in 22 patients.

There are various reconstruction options available for facial soft tissue defect which depends on site and size of defect and should be individualized for every patient. Findings of our study are consistent with that primary repair of wound and locoregional flaps are appropriate method for facial soft tissue reconstruction as they provide good aesthetic and functional results with better color and texture match of donor and recipient tissue. There are various studies in literature which are done in past on reconstruction of soft tissue defect of face showing demographic data but further studies are required for functional and aesthetic assessment and comparison of various methods which are used for facial soft tissue reconstruction.

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