elastin and Facial-Injuries

Management of full-thickness facial burns remains one of the greatest challenges. Controversy exists among surgeons regarding the use of early excision for facial burns. Unfortunately, delayed excision of deeper burns often results in more scarring and subsequent reconstruction becomes more difficult. A collagen-elastin matrix is used to improve the quality of the reconstructed skin, to reduce scarring and to prevent wound contraction. It serves as a foundation for split thickness skin graft and enhances short and long-term results.. We report the usage of a collagen-elastin matrix during single-step wound closure technique of severe full-thickness facial burns in 15 children with large burned body surface area, and also we review the literature about pediatric facial burns.. There were 15 pediatric patients with severe facial burns, 8 girls and 7 boys ranging in age from 10 months to 12 years, mean age 7 years and 6 months old. The facial burn surface area (FBSA) among the patients includes seven patients with 100%, five with 75%, and three with 50%. The average total body surface area (TBSA) for the patients was 72%, ranging between 50 and 90%. 5 of the patients' admissions were late, more than four days after burns while the rest of the patients were admitted within the first four days (acute admission time). The burns were caused by flame in eight of the patients, bomb blast in four, and scalding in three. All patients were treated by the simultaneous application of the collagen-elastin matrix and an unmeshed split thickness skin graft at Turgut Özal Medical Center, Pediatric Burn Center, Malatya, Turkey. After the treatment only two patients needed a second operation for revision of the grafts. All grafts transplanted to the face survived. The average Vancouver scar scales (VSS) were 2.55±1.42, ranging between one and six, in the first 10 of 15 patients at the end of 6 months postoperatively. VSS measurements of the last 5 patients were not taken since the 6 months postoperative period was not over.. In regard to early results, graft quality was close to normal skin in terms of vascularity, elasticity, pliability, texture and color. Esthetic and functional results have been encouraging. This study shows us that the collagen-elastin matrix as a dermal substitute is a useful adjunct, which may result in quick healing with satisfying esthetic and functional results. It also may enhance short and long-term results in after burn facial wound closure in children.

Topics: Body Surface Area; Burns; Child; Child, Preschool; Collagen; Elastin; Esthetics; Facial Injuries; Female; Graft Survival; Humans; Infant; Male; Reoperation; Skin Transplantation; Skin, Artificial; Trauma Severity Indices; Treatment Outcome; Turkey

Facial burns remain a complex reconstructive challenge. Achieving the plastic surgical goals of restoring form and function is difficult in these cases, with poor cosmetic results, reduced facial animation, and oral and ocular contractures a common result. In recent years, the use of dermal substitutes in combination with skin grafts has shown promising results in complex burn reconstruction. A 3-year-old girl was admitted to our pediatric tertiary referral center with 60% TBSA full-thickness burns, involving all skin above the waist including the face and neck. She underwent staged debridement of burnt tissue and temporary coverage with cadaveric skin over a 2-week period. Facial reconstruction was achieved by placement of Matriderm acellular dermal matrix covered with sheet split skin grafts, both in aesthetic subunits, at 2 weeks post-burn. Graft take on day 5 was 95%, with the small area of loss successfully regrafted. Twelve-month follow-up demonstrates great aesthetic results in terms of texture and color, as well as normal ocular and near-normal oral function. Use of Matriderm beneath split skin grafts demonstrates promising results for both aesthetic outcome and functional skin movement in burn reconstruction. Our results provide early evidence in favor of this new technique in full-thickness facial burns in pediatric patients.

Topics: Burns; Child, Preschool; Collagen; Debridement; Elastin; Esthetics; Facial Injuries; Female; Humans; Plastic Surgery Procedures; Skin Transplantation