TY - JOUR
T1 - Reconstructive management of devastating electrical injuries to the face
AU - Janis, Jeffrey E.
AU - Khansa, Ibrahim
AU - Lehrman, Craig R.
AU - Orgill, Dennis P.
AU - Pomahac, Bohdan
N1 - Publisher Copyright:
Copyright © 2015 by the American Society of Plastic Surgeons.
PY - 2015/10/1
Y1 - 2015/10/1
N2 - Background: Devastating fourth-degree electrical injuries to the face and head pose significant reconstructive challenges. To date, there have been few peerreviewed articles in the literature that describe those reconstructive challenges. The authors present the largest case series to date that describes the management of these injuries, including the incorporation of face transplantation. Methods: A retrospective case series was conducted of patients with devastating electrical injuries to the face who were managed at two level-1 trauma centers between 2007 and 2011. Data describing patient injuries, initial management, and reconstructive procedures were 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. The authors describe differences in management between the two trauma centers, one of which had the availability for composite tissue allotransplantation; the other did not. Also described is how initial attempts at traditional reconstruction affected the eventual face transplantation. Conclusions: The care of patients with complex electrical burns must be conducted in a multidisciplinary fashion. As with all other trauma, the initial priority should be management of the airway, breathing, and circulation. Additional considerations include cardiac arrhythmias and renal impairment attributable to myoglobinuria. Before embarking on aggressive reconstruction attempts, it is advisable to determine early whether the patient is a candidate for face transplantation in order to avoid antigen sensitization, loss of a reconstructive "lifeboat," surgical plane disruption, and sacrifice of potential recipient vessels.
AB - Background: Devastating fourth-degree electrical injuries to the face and head pose significant reconstructive challenges. To date, there have been few peerreviewed articles in the literature that describe those reconstructive challenges. The authors present the largest case series to date that describes the management of these injuries, including the incorporation of face transplantation. Methods: A retrospective case series was conducted of patients with devastating electrical injuries to the face who were managed at two level-1 trauma centers between 2007 and 2011. Data describing patient injuries, initial management, and reconstructive procedures were 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. The authors describe differences in management between the two trauma centers, one of which had the availability for composite tissue allotransplantation; the other did not. Also described is how initial attempts at traditional reconstruction affected the eventual face transplantation. Conclusions: The care of patients with complex electrical burns must be conducted in a multidisciplinary fashion. As with all other trauma, the initial priority should be management of the airway, breathing, and circulation. Additional considerations include cardiac arrhythmias and renal impairment attributable to myoglobinuria. Before embarking on aggressive reconstruction attempts, it is advisable to determine early whether the patient is a candidate for face transplantation in order to avoid antigen sensitization, loss of a reconstructive "lifeboat," surgical plane disruption, and sacrifice of potential recipient vessels.
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U2 - 10.1097/PRS.0000000000001619
DO - 10.1097/PRS.0000000000001619
M3 - Article
C2 - 26090762
AN - SCOPUS:84942428274
SN - 0032-1052
VL - 136
SP - 839
EP - 847
JO - Plastic and reconstructive surgery
JF - Plastic and reconstructive surgery
IS - 4
ER -