20 - Management of the burned face and neck

Abstract

The face defines a person’s identity. It is the seat of beauty and expression which, when injured, can cause considerable physical and mental anguish. It constitutes a myriad of structures with a rich blood supply making facial burns a unique entity while estimating extent and depth. Laser Doppler imaging can be a good adjunct to sound clinical judgment to assess depth. Early management of facial burns consists of damage control, depth assessment, and good topical care with splintage. Goals of wound management in the early post-burn period include moist wound care, hastening re-epithelialization, judicious early excision, preserving aesthetic landmarks and ensuring compliance to scar management aftercare. Open dressings versus closed is still a debatable point when it comes to facial burns treatment. Judicious use of advanced wound care products and skin substitutes can shorten wound healing times and improve scar outcomes. Early excision with cover using autograft or skin substitutes is the standard of care in full-thickness burns. Delayed presentation with scars and contractures is a reconstructive challenge met by detailed functional and psychological assessment, meticulous planning, counseling, and consenting. Principles of facial burn reconstruction include revisiting aesthetic subunits and choosing options from the reconstructive ladder to stage surgeries appropriately. Innovations like 3D printing and advancements like skin sprays, skin substitutes, and stem cell therapy pave the way for the future in facial burn care. Face transplants, with newer advancements in immunotherapy and transplant medicine, is now a viable option for facial burns with severe disfigurement. Throughout the various phases of facial burn care, empathy and understanding has to be maintained, nurturing the patient’s self-image and confidence while keeping expectations of outcomes realistic. Psychosocial and vocational reintegration play a paramount role in facial burn rehabilitation.