547 Face Escharotomy in an Acute Deep Facial Burn

Abstract

Abstract Introduction Escharotomy is the relaxation of the eschar through longitudinal or horizontal incisions in order to protect the region’s deep perfusion. The pressure that it will create in the peripheral areas such as hard eschar limb, trunk, and neck causes the circulatory disorder in the limb and the risk of limb loss, inadequate thoracic expansion in the thorax and vital perfusion and oxygenation problems in the neck. It is one of the most basic rules of burn surgery to perform the determined escharotomy incisions very quickly and without hesitation to prevent complications. In this report, a case of facial subunit principles based escharotomy is presented. Methods 42-year-old man felt into hot sand while working in an iron and steel factory. Patient was transferred to our burn unit for corresponding 35% of the total body surface burns on the face, neck and upper extremities. The patient was consulted to plastic surgery after the initiation of fluid replacement therapy, insertion of a chest tube for hemothorax, and tracheostomy. The patient had massive edema in the face and neck (Figure 1). There was no capillary fill in the facial skin. Doppler ultrasound examination showed bilateral weak facial artery, temporal superficial artery, supraorbital and trochlear artery flow. Results A decision was made to perform escharotomy to relieve arterial traces at 10th hour of the injury. Bilateral nasolabial, infraorbital rim, superior glabellar, temporal incisions were performed from eschar to subcutaneous fat layer in accordance with aesthetic subunits (Figure 2). Relief of the base perfusion during escharotomy was observed and bleeding was observed at the base of the incision. Doppler examination was repeated after escharotomy. The facial edema rapidly regressed. Deepitelization and reepithelization was observed in the areas with hair roots within 10 days and the patient was operated on the 15th day of hospitalization for debridement and skin grafting. Eschars were debrided and covered with split thickness skin grafts according to aesthetic subunit principles. Post-operative image of the patient seen (Figure 3). Conclusions Face is not an area in which eschar formation commonly seen because of its robust vascular supply and protection reflex of the patients. Although descriptive drawings and guides for facial escharotomy has not been published yet, relaxation of axial arteries in terms of compression due to eschar formation may be needed. In this report, a case of facial subunit principles based escharotomy is presented and acceptable results were achieved.