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Affiliation
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1Department of Plastic Surgery, The Ohio State University Wexner Medical Center, Columbus, OH 43212 2Department of Plastic Surgery, The University of Texas-Southwestern Medical Center, Dallas, TX 75390 3Department of Plastic Surgery, Harvard Medical School, Boston, MA 02115. |
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Abstract
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BACKGROUND: Devastating fourth-degree electrical injuries to the face and head pose significant reconstructive challenges. To date, there have been few peer-reviewed articles in the literature describing those reconstructive challenges. We present the largest case series describing the management of these injuries to date, including the incorporation of face transplantation.
METHODS: A retrospective case series of patients with devastating electrical injuries to the face, managed at two level I trauma centers between 2007 and 2011, was conducted. Data describing the patients' injury, initial management and reconstructive procedures was collected.
RESULTS: Five patients with devastating electrical injuries to the face were reviewed. After initial stabilization and treatment of life-threatening injuries, all five underwent burn excision and microsurgical reconstruction using distant flaps. Two of the patients eventually underwent face transplantation. We describe differences in management between the two trauma centers, one of which had the availability for composite tissue allotransplantation, while the other did not. We also describe how initial attempts at traditional reconstruction affected the eventual facial transplantation.
CONCLUSIONS: The care of patients with complex electrical burns must be conducted in multidisciplinary fashion. Like all other trauma, the initial priority should be the management of the airway, breathing and circulation. Additional considerations include cardiac arrhythmias and renal impairment due to myoglobinuria. It is advisable to determine early whether the patient is a candidate for facial transplantation, before embarking on aggressive reconstruction attempts, in order to avoid antigen sensitization, loss of a reconstructive "lifeboat", surgical plane disruption, and sacrifice of potential recipient vessels.
Language: en |