Head and neck burns: acute and late reconstruction.data of burn injury management in 2007

Modern burn care is based on operative wound management. The evidence is clear that prompt excision and closure can be lifesaving for patients even with large burns. Facial burns that are full-thickness need grafting. Deep dermal facial burns need surgery in the third week post-burn. Deep burns to the eyelids should be excised and grafted early in order to prevent cicatricial ectropion and corneal exposure. Following healing from burns, the reconstruction of severe deformities and scars of the face, head, and neck confronts the surgeon with some of the most challenging problems in reconstructive surgery. Our purpose is to provide some retrospective data on acute and late reconstruction of head and neck burns in 2007. Eighty-one patients are considered who were operated on in the Burns and Plastic Surgery Service of the University Hospital Centre in Tirana, Albania, suffering from burns and also from burn deformities in the head and neck regions. A description is given of the different types of operative techniques used for head and neck reconstruction as also of developmental aspects of burned face deformities (physical and psychological) and of their correction. In all, 246 patients with burns and burn deformities were subjected to surgery in 2007. Of these we have extracted 81 cases in which the pathology concerned the head and the neck, including 13 cases of full-thickness facial burns needing excising and grafting. The other 68 cases were burn deformities. This last group of patients included 19 with facial deformities, 14 with perioral deformities, 12 with burn alopecia, ten with upper and lower eyelid deformities, nine with ear deformities, and four with cervical deformities. The operative techniques used were skin grafts (split-thickness or full-thickness), composite grafts, pedicle flaps, and tissue replacement. In burn alopecia cases, we used tissue expansion for the correction. Head and neck burns constitute some of the most challenging problems in acute wound care and in the subsequent rehabilitation and reconstruction.With knowledge of the reconstruction techniques available, plus an accurate diagnosis of tissue deficiency and secondary distortion, a carefully performed surgical plan is the first step for achieving improvements in a burn-deformed face.