Reconstructive Management of Devastating Electrical Injuries to the Face

Area of Science:

• Reconstructive surgery
• Trauma surgery
• Electrical injury management

Background:

• Devastating fourth-degree electrical injuries to the face and head present significant reconstructive challenges.
• Few peer-reviewed articles detail the management of these complex injuries.
• This study presents the largest case series on managing facial electrical injuries, including face transplantation.

Observation:

• A retrospective case series reviewed five patients with severe facial electrical injuries treated between 2007 and 2011 at two level-1 trauma centers.
• All patients underwent burn excision and microsurgical reconstruction with distant flaps.
• Two patients ultimately received face transplants, with management differing based on center capabilities.

Findings:

• Initial stabilization and life-saving treatments were prioritized.
• Microsurgical reconstruction using distant flaps was performed on all patients.
• The impact of prior reconstruction attempts on subsequent face transplantation was analyzed.

Implications:

• Multidisciplinary care is essential for patients with complex electrical burns.
• Early assessment for face transplantation candidacy is advised to prevent complications like antigen sensitization and loss of reconstructive options.
• Prioritizing airway, breathing, and circulation, alongside managing potential cardiac and renal issues, is critical.