The news media and internet have been buzzing with stories about a recent tragedy in Miami, Florida. A homeless man in Miami Beach, under the influence of a drug-induced high, cannibalized another homeless man. The attacker was eating the victim’s face and was eventually shot and killed by a police officer because he refused to stop.
The bizarre attack generated rumors of zombie behavior and soon gruesome photographs of a faceless victim spread throughout the internet. The victim was taken to a Miami trauma center for treatment and is currently recovering. I have been asked to comment on the reconstructive aspects of such an unusual and complex case.
I recall a very similar patient I personally cared for in New York many years ago. Early one morning I was called to our trauma center emergency department to see a young man with a severe facial injury. He had gotten drunk and argued with his mother. He decided to commit suicide and fired a shotgun under his chin. However, the gun angle was forward and his face took the full effect of the blast injury.
Where Do You Start?
The management of these complex facial injuries is divided into 3 phases. The initial phase is acute resuscitation. Just as with any other trauma patient, the ABC’s of airway, breathing, and circulation, must be followed. Often tissue debris or blood can obstruct the airway and compromise breathing. Lacerations to large arteries can also cause significant blood loss.
Once the patient is deemed stable the initial goal is to surgically clean the tissue and close or cover open wounds in order to allow healing and prevent infection. Wound closure can be difficult if there is a deficiency of tissue. The judicious use of biologic dressings and skin grafts is important. In addition, during the subacute phase, infection is a risk because the human mouth contains a high density of bacteria. Strong antibiotics and vigorous wound care are critical during this period which can last for weeks or months.
The third, or reconstructive, phase will require multiple surgical procedures likely over several years. The principle followed by plastic surgeons in such cases is to give priority to function, such as sight, smell, eating and speech. Cosmetic considerations, although important, are secondary to function. Bony structures, if jaw damage exists, are reconstructed first and then soft tissue is built upon this foundation.
Many options exist for reconstruction, however, the patient’s own tissue will generally be the most compatible. For example, a jaw can be framed from the patient’s own hipbone. If possible, it is preferable to use adjacent facial skin and muscle. If damage is too extensive then soft tissue can be harvested from other body areas such as the arm or even the buttocks and transferred to the face by microscopic attachment. Recently, headlines have been made by full face transplantation. These complex reconstructive cases typically require multiple professionals, including surgeons, dentists, therapists, nurses, social workers and others to work cooperatively.
About the Author:
Dr. Perez is plastic and reconstructive surgeon in Ft. Lauderdale, Florida. He is a graduate of The Albert Einstein College of Medicine in New York. Dr. Perez has been selected among Castle Connolly/U.S. News and World Report’s America’s Top Doctorsevery year since 2000 (again for 2012-2013). He has lectured internationally and been featured as a plastic surgery expert for major media outlets.
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