Early Excision and Grafting of Face and Neck Burns in Patients over 20 Years

Abstract

Although excision and grafting of burns has become common and standard, many surgeons have been reluctant to excise and graft face burns. In fact, we could find photographic results at 1 year after grafting of only eight patients in the English literature. We began excision and grafting of face burns in 1979 and presented our first 16 patients in 1986 in this journal. With encouragement from Janzekovic and Jackson, we continued and have now used essentially the same procedure for more than 20 years in approximately 100 patients and, from this large series, are able to present outcomes. From January of 1979 to May of 1999, we performed excision and grafting on 91 patients with deep face burns. Data were recorded and 35-mm photographs were obtained throughout the 20-year period. We reviewed that database and the slide files of these patients. We found 45 patients with complete photographic sets including 1-year follow-up. Since, in our opinion, there is no useful, objective measure of appearance, we decided to simply publish all 45 sets of complete photographs, permitting the reader to subjectively form an opinion of the outcome of this procedure. The results are all shown as "full" face burns and two "partial" face burns. We continue to believe that early excision and grafting is indicated for face burns that will not heal within 3 weeks and that the procedure yields results that permit the burn victims to return to society and minimizes the time off work or out of school.

Burn Wound Infections

“…However, an improved understanding of the pathophysiology of burns allowed the advancement of multiple intra-and postoperative medical and surgical techniques that has resulted in gradual decreases in morbidity and mortality (66,87,127,181,196,200,470). Medical support to maintain hemodynamic and respiratory function within the trauma intensive care unit and operating theater, the provision of early adequate nutrition, and the use of surgical techniques that minimize blood and heat loss allowed this approach to become the standard of care for large thermal injuries in modern burn centers.…”

Folk medicine: Is the solution or problem?

“…It was not possible to remove of paint applied to the burned area. We used the Versajet Hydrosurgery System working with principle of the Venturi effect [17]. This product eliminates shoe polish in a perfect manner and provides minimal damage to remaining healthy tissue.…”

Inability to determine tissue health is main indication of allograft use in intermediate extent burns

“…The face is a unique anatomic area that is rightly treated differently from other areas of the body [31][32][33][34][35][36]. While there is a consensus that early excision and grafting in facial burns should be reserved for burns not expected to heal spontaneously by the third week after burn [32][33][34][35], there is little objectivity in that determination. Underexcision of facial burns leads to partial graft take and scarring, whereas deep excisions may damage facial musculature and nerves.…”