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Management of pediatric facial burns
T A Housinger1, J Hills, G D Warden
1Department of Surgery, University of Cincinnati, OH.
Insights
Early excision and grafting of pediatric facial burns is safe and effective. This approach allows for timely wound coverage, reducing the need for regrafting and improving outcomes in young patients.
Area of Science:
- Plastic Surgery
- Pediatric Burn Management
Background:
- Pediatric facial burn management lacks uniform protocols.
- Concerns exist regarding early surgical intervention in young children.
- Early excision and grafting is an alternative approach.
Purpose of the Study:
- To evaluate the safety and efficacy of early excision and grafting for pediatric facial burns.
- To present institutional experience with this surgical technique.
Main Methods:
- Retrospective review of 66 pediatric patients with facial burns.
- Mean age of patients was 6.2 years.
- Procedures involved two-stage early excision and open-dressed grafting, with mean grafting at 12.7 days post-burn.
Main Results:
- No airway complications or need for regrafting occurred.
- Patients wore pressure masks for a mean of 15.5 months.
- Thirteen patients required reconstructive releases (eyelids, lips) in the first year.
Conclusions:
- Early excision and grafting of pediatric facial burns is a safe and viable option.
- This technique facilitates early wound coverage, offering benefits to pediatric burn patients.
Abstract:
The acute management of pediatric facial burns is not uniform. Many surgeons prefer to wait until primary wound separation occurs before grafting. Concerns over early excision are accentuated in small pediatric patients. The possible benefits of early excision results have led to adoption of this technique at our facility. This study presents our recent experience with early excision and grafting. Sixty-six patients with a mean age of 6.2 years underwent early excision and grafting of facial burns. Patients underwent grafting a mean 12.7 days after burn. Procedures were done in two stages. All grafts were dressed open. There were no episodes of acute airway decompensation. No patient required regrafting. Patients wore pressure masks a mean of 15.5 months after grafting. Thirteen patients had releases (10 eyelids, three lips/commissures) in the first postoperative year. These results demonstrate that early excision and grafting of facial burns can be carried out safely in pediatric patients with burns. The benefits of early wound coverage can thus be applied to facial burns in this population of patients.