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Page 6 of 11 Pang et al. Plast Aesthet Res 2021;8:49 https://dx.doi.org/10.20517/2347-9264.2021.42

Figure 2. (A) A 31-year-old male presented with a gunshot wound to the oromandibular complex resulting in massive lower and
midface trauma; (B) oral cutaneous fistula present in the anterior floor of mouth; (C) fibula free flap contoured to the defect for
restoration of mandibular continuity; (D) 1-year post-injury result.

Figure 3. (A) A 23-year-old male who sustained a self-inflicted gunshot wound to the face, initial encounter; (B) ten days after the initial
injury, repair of nasal Le Fort II fractures was performed with split calvarial bone grafts; (C) telecanthus as the result of migration of
canthal tendons; (D) post-operative result after resuspension of medial canthi to screws placed into the frontal bone.

Microstomia
Oral incompetence and microstomia may manifest after severe facial trauma, often as the result of late
sequelae and scarring. The reader is directed towards more comprehensive sources reviewing contemporary
[28]
perioral reconstruction ; however, several key principles deserve attention. Firstly, restoring dynamic
motion and sensation is paramount. To that end, local reconstructive techniques, including cheek
advancement techniques, Karapandzic flaps [Figure 4A-D], and commisuroplasties, are highly effective in
restoring defects of less than 80% of the lips [29-32] . Hanasono and Langstein report the extension of the
[30]
traditional Karapandzic flap technique to include tissue from the perioral cheek, allowing near-total lower
lip defects to be reconstructed with sensation and dynamic function. When local flaps are insufficient, the
radial forearm free flap has traditionally been the most favorable donor site given its thinness and pliability.