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

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.