Surgical site infection and patient reported outcomes in surgically treated soft tissue facial injury:A Meta-Analysis

Background: Soft tissue facial injuries (STFI) constitute a significant portion of craniofacial trauma but the risk of surgical site infection (SSI) and the patient-reported outcomes (PROs) following surgical management of STFI are unknown.
Methods: A PRISMA-compliant search was conducted, and meta-analysis was performed using R. Pooled effects of outcomes were estimated using the DerSimonian and Laird random-effects model/generalised linear mixed model, when feasible.
Result: Out of 8,897 screened studies, 38 were included. 12 studies reported PROMs, while 28 studies reported SSI rates following operative treatment for STFI. The pooled SSI rate (n=28) was 3.30% (95%CI 1.89%-5.71%). Surgical and non-surgical closure didn't differ significantly in SSI rate. PROs focused on scar outcomes, cosmetic outcomes, quality of life, and psychological impact. Subgroup analysis showed lower SSI risk in operative repair for general facial trauma compared to primary repair, and in general facial trauma compared to other aetiologies. The direct pairwise analysis of surgical closure versus tissue adhesive in SSI rate (n=5) was found to have no statistically significant superiority (RR 1.91 (95%CI 0.63-5.82, p=0.585, I2 = 0%). The pooled patient scar assessment scale (PSAS), score at 6-12 months post-intervention (5 studies, n=217) was 16.16 (95%CI 15.34-16.97). Limited evidence was found regarding the effect and superiority of surgical treatment in cosmetic outcomes, quality of life and psychological impact.
Conclusion: Our findings emphasise the limited and unreliable evidence available concerning PROs following operative treatment for STFI. Future studies employing robust methodologies are needed to investigate optimal approaches for managing STFI effectively.

Craniomaxillofacial/Head and Neck

PSTM 2024