gms | German Medical Science

34. Jahrestagung der Deutschsprachigen Arbeitsgemeinschaft für Verbrennungsbehandlung (DAV 2016)

13. - 16.01.2016, Berchtesgaden

Periorbital reconstruction in full thickness facial burn – Timing and technique

Meeting Abstract

  • Christian Tschumi - Universitätsspital Zürich, Klinik für Plastische Chirurgie und Handchirurgie, Zürich, Schweiz
  • Sophia Mirtschink - Universitätsspital Zürich, Klinik für Plastische Chirurgie und Handchirurgie, Zürich, Schweiz
  • Pietro Giovanoli - Universitätsspital Zürich, Klinik für Plastische Chirurgie und Handchirurgie, Zürich, Schweiz
  • Jan Plock - Zürich, Schweiz

Deutschsprachige Arbeitsgemeinschaft für Verbrennungsbehandlung. 34. Jahrestagung der Deutschsprachigen Arbeitsgemeinschaft für Verbrennungsbehandlung (DAV 2016). Berchtesgaden, Deutschland, 13.-16.01.2016. Düsseldorf: German Medical Science GMS Publishing House; 2016. Doc16dav31

doi: 10.3205/16dav31, urn:nbn:de:0183-16dav315

Published: January 12, 2016

© 2016 Tschumi et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.


Outline

Text

Background: In third degree facial burns the management and reconstruction of the periorbital zone is a challenging part. Adequate treatment can minimize ocular damage such as exposure keratitis, corneal ulcers, conjunctivitis, all of which can potentially result in blindness.

Method: Between 06/2014 and 06/2015 four patients (2 male, 2 female, mean age 43.8 years) with bilateral full thickness periorbital burns were admitted in our clinic with a mean burn size of 66.5% total body surface area. All patients underwent tangential excisions and sheet grafting along the aesthetic units of the face as soon as wound conditioning occurred. Consequent prophylactic ocular lubrication and moisture chambers were applied. Upper and lower eyelid release with full thickness skin grafting and lateral canthopexy usually with a temporary tarsorrhaphy were performed (mean 56 days, range 29 to 74). In one case we used the ReCell-technic and autologous keratinocytes transplantation. On average 3 operations per patient were performed and the mean time till final reconstruction of the periorbital zone was 165.5 days (range 98 to 244). Because of an extended defect of the upper eyelid one patient underwent complex upper and lower lid reconstruction including local flaps (Mustarde-flap, lid-switch-flap).

Conclusion: Periorbital involvement is prevalent in facial burn and surgical intervention is mandatory as eyelid retraction causes cornea exposure. Although each case should be approached individually eyelid release with full thickness skin graft and lateral canthopexy may frequently be useful. In our experience lateral canthopexy should always be performed transosseous to achieve a vector in cranial and posterior direction to avoid early recurrence.