Head and neck burns. Evaluation and current management

More than half of the 150,000 burn patients hospitalized in the United States each year have head and neck involvement, with 3% to 7% sustaining concomitant inhalation injury. With advances in fluid replacement therapy and specialized burn care units, mortality has fallen from near 100% to 24% for burns of 75% to 90% of body surface area. The most common causes of death are respiratory complications and sepsis. Inhalation injuries can be diagnosed by laryngoscopy, and compromised airways can then be intubated (with tracheotomy for long-term management) and sloughing mucosa and inspissated mucus removed by serial bronchoscopy. Sepsis is minimized by early excision of burn eschar and autografting or, in the widely burned, temporary coverage with cadaver allograft, porcine xerograft, or skin substitutes until successive crops of autografts are available. The head and neck presents substantial reconstructive and rehabilitative challenges, which must be addressed in aesthetic units.