Reconstruction of post burns facial contractures and deformities: an Indian perspective

Authors

  • Niyati Lakhani Department of Surgery, GMERS Medical College, Gandhinagar, Gujarat, India
  • Ashwin Lakhani Consultant Plastic surgeon, Dhyey Hospital, Ahmedabad, Gujarat, India

DOI:

https://doi.org/10.18203/2349-2902.isj20182216

Keywords:

Burn, Facial deformities, Reconstruction, Scar

Abstract

Background: Reconstruction of facial burns contracture is one of the most important surgeries in cosmetic and reconstructive surgery. This study was aimed to assess the different modalities used in facial reconstruction and their outcome.

Methods: This retrospective study involved 20 patients with extensive burning facial scars. Patients were treated with different reconstructive modalities like split/full thickness skin grafts or flaps etc. Outcome of different modalities as per the area of face involved, graft taken up and complications were analyzed.

Results: Majority patients were of age between 20-30 years. 72.22% patients had other associated burn injuries with facial involvement. Most patients (18, 90%) were treated after 9 months post burns duration. All patients had multiregional involvement on face but cheek being the largest unit, was most commonly involved (18, 90%) followed by involvement of oral commissure and lips in 8 (40%) and orbital region in 7 (35%) patients. Full thickness skin graft (FTSG) and split thickness skin grafts (STSG) were most commonly performed procedures. Patient with forehead scarring was treated with abdominal tube transferred in stages. Two patients with eyelid ectropion treated with release and STSG. Gillies up and down forehead flap were used for nose reconstruction due to non-availability of tissue expanders. Linear scars on chick not fitting in relaxed skin tension line were treated with excision and primary “z” plasty. Hypertrophic scar of ear was excised and STSG was applied. Common complications included hyperpigmentation and hypopigmentation, contour distortion and obliteration of labiomental sulcus.

Conclusions: Facial reconstructive procedure for burns scars should be selected based on region of face involved. Skin grafting is an effective method for reconstruction especially in areas with non-availability of advanced treatment modalities.

References

Perry ZH, Palivatkel M, Yanculewitch N, Koren L, Rosenberg N. Burns-risk factors and treatment. Harefuah. 2009;148:375-80,411,412.

Hayashida K, Akita S. Surgical treatment algorithms for post-burn contractures. Burns Trauma. 2017;5:9.

Peck M, Molnar J, Swart D. A global plan for burn prevention and care. Bull World Health Organ. 2009;87:802-3.

Ortiz LC, Carrasco VA, Torres NA, Sempere NL, Mendoza MM. Supraclavicular bilobed fasciocutaneous flap for postburn cervical contractures. Burns. 2007;33:770-5.

Dowling JA, Foley FD, Moncrief JA. Chondritis in the burned ear. Plast Reconstr Surg. 1968;42:115.

Feldman JJ. Facial Burns. In: Plastic Surgery, Ed. McCarthy J. G. W. B. Saunders Co., Philadelphia; 1990:2153-236.

Bayat A, McGrouther DA, Ferguson MW. Skin scarring. BMJ. 2003;326:88-92.

Margulis A, Agam K, Icekson M, Dotan L, Yanko-Arzi R, Neuman R. The expanded supraclavicular flap, prefabricated with thoracoacromial vessels, for reconstruction of postburn anterior cervical contractures. Plast Reconstr Surg. 2007;119:2072-7.

Paul AC, Swapan KB, Spronk CA. Postburn contracture treatment: a healthcare project in Bangladesh. Burns. 2008;34:181-4.

Telang P, Jagannathan M, Devale M. A study of the use of the supraclavicular artery flap for resurfacing of head, neck, and upper torso defects. Indian J Plast Surg. 2009;42:4-12.

Ullah F, Obaidullah, Tahir M. Management of postburn digital flexion contractures. J Coll Physicians Surg Pak. 2005:15631-3.

Goel A, Shrivastava P. Post-burn scars and scar contractures. Indian J Plast Surg. 2010;43:63-71.

Donelane MB. Principles of burn reconstruction. In: Thorne CH, Beasley RW, Aston SJ, Bartlett SP, Gurtner GC, Spear SL, eds. Grabb and Smith’s Plastic Surgery. 6th ed. Lippincott Williams and Wilkins, Philadelphia; 2007:150-61

Harrison CA, MacNeil S. The mechanism of skin graft contraction: An update on current research and potential future therapies. Burns. 2008;34:153-63.

Iwuagwa FC, Wilson D, Bailie F. The use of skin grafts in burn contracture release: a 10-year review. Plast Reconstr Surg. 1999;103:1198-204.

Rudulph R, Ballantyne DL. Skin Grafts. In: McCarthy JG, ed. Plastic Surgery. WB Saunders Co, Philadelphia; 1990:221-74.

Kritikos O, Tsoutsos D, Papadopoulos S, Zapadioti P, Tsagarakis M, Grabec P. The use of artificial skin in plastic surgery and burns. Acta Chirurgiae Plasticae. 2006;48(2):43-7.

Philp L, Umraw N, Cartotto R. Late outcomes after grafting of the severely burned face: a quality improvement initiative. J Burn Care Res. 2012;33:46-56.

Malhotra R, Sheikh I, Dheansa B. The management of eyelid burns. Surv Ophthalmol. 2009;54:356-71.

Alghoul M, Pacella SJ, McClellan WT, Codner MA. Eyelid reconstruction. Plast Reconstr Surg. 2013;132:288e-302e.

Juli J. Eyebrow reconstruction. Plast Reconstr Surg. 2001;107:1225-8.

Elbanoby TM, Elbatawy A, Aly GM, Ayad W, Helmy Y, Helmy E, et al. Bifurcated superficial temporal artery island flap for the reconstruction of a periorbital burn: an innovation. Plast Reconstr Surg Glob Open. 2016;4:e748.

Fujioka M, Hayashida K, Murakami C, Koga Y. Reconstruction of total nasal defect including skin, bone, and lining, using a single free radial forearm osteocutaneous perforator flap. Plast Reconstr Surg. 2012;129:854e-7e.

Krastinova D, Bach CA. Secondary reconstruction of burned nasal alae using rolled dermal flap with overlying full-thickness skin graft. Eur Ann Otorhinolaryngol Head Nech Dis. 2011;128:1-6.

Saadeldeen WM. Cheiloplasty in post-burn deformed lips. Ann Burns Fire Disasters. 2009;22:90-6.

Downloads

Published

2018-05-24

Issue

Section

Original Research Articles