A modified surgical technique in the management of eyelid burns: a case series

Haiying Liu,Shudong Sun,Qigang Wang,Youxin Ji,Kun Wang

doi:10.1186/1752-1947-5-373

Haiying Liu, Shudong Sun + Show 3 more

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https://doi.org/10.1186/1752-1947-5-373

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Abstract

IntroductionContractures, ectropion and scarring, the most common sequelae of skin grafts after eyelid burn injuries, can result in corneal exposure, corneal ulceration and even blindness. Split-thickness or full-thickness skin grafts are commonly used for the treatment of acute eyelid burns. Plasma exudation and infection are common early complications of eyelid burns, which decrease the success rate of grafts.Case presentationWe present the cases of eight patients, two Chinese women and six Chinese men. The first Chinese woman was 36 years old, with 70% body surface area second or third degree flame burn injuries involving her eyelids on both sides. The other Chinese woman was 28 years old, with sulfuric acid burns on her face and third degree burn on her eyelids. The six Chinese men were aged 21, 31, 38, 42, 44, and 55 years, respectively. The 38-year-old patient was transferred from the ER with 80% body surface area second or third degree flame burn injuries and third degree burn injuries to his eyelids. The other five men were all patients with flame burn injuries, with 7% to 10% body surface area third degree burns and eyelids involved. All patients were treated with a modified surgical procedure consisting of separation and loosening of the musculus orbicularis oculi between tarsal plate and septum orbital, followed by grafting a large full-thickness skin graft in three days after burn injury. The use of our modified surgical procedure resulted in 100% successful eyelid grafting on first attempt, and all our patients were in good condition at six-month follow-up.ConclusionsThis new surgical technique is highly successful in treating eyelid burn injuries, especially flame burn injuries of the eyelid.

Highlights

Contractures, ectropion and scarring, the most common sequelae of skin grafts after eyelid burn injuries, can result in corneal exposure, corneal ulceration and even blindness
The success rate of corneal transplants is less than 50%, often requiring multiple attempts before success is achieved
Management is critical in the eyelid burn patient, including non-surgical measures such as the use of artificial tears and moist gauze covering of the eyes to prevent drying of the cornea

Summary

Introduction

Eyelid involvement is common in facial burns. Treatment of eyelid burn injuries requires great care for the protection of the cornea. Case presentation Case 1 was a 36-year-old Chinese woman who was diagnosed with flame burn three hours after injury. Her injuries were second or third degree burns involving the total head, anterior and posterior torso, both arms and parts of both thighs. Cases 3, 4, 5, 6 and 7 were all Chinese men aged 21, 31, 42, 44 and 55, respectively; flame burn was diagnosed three to five hours after injury with 7% to 10% BSA third degree burns involving the face, neck, both forearms and both hands. All eight patients had second and/or third degree eyelid burns, and five had partial musculus orbicularis oculi burns, but with the tarsal plate intact. One patient’s preoperative and post-operative follow-up pictures are included (Figure 5, Figure 6, Figure 7, Figure 8 and 9)

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