Reconstructive management of devastating electrical injuries to the face

Jeffrey E. Janis, Ibrahim Khansa, Craig R. Lehrman, Dennis P. Orgill, Bohdan Pomahac

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)839-847
Number of pages9
JournalPlastic and Reconstructive Surgery
Volume136
Issue number4
DOIs
StatePublished - Oct 1 2015

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Facial Transplantation
Wounds and Injuries
Trauma Centers
Vascularized Composite Allotransplantation
Myoglobinuria
Airway Management
Burns
Cardiac Arrhythmias
Patient Care
Respiration
Head
Kidney
Antigens

ASJC Scopus subject areas

  • Surgery

Cite this

Janis, J. E., Khansa, I., Lehrman, C. R., Orgill, D. P., & Pomahac, B. (2015). Reconstructive management of devastating electrical injuries to the face. Plastic and Reconstructive Surgery, 136(4), 839-847. https://doi.org/10.1097/PRS.0000000000001619

Reconstructive management of devastating electrical injuries to the face. / Janis, Jeffrey E.; Khansa, Ibrahim; Lehrman, Craig R.; Orgill, Dennis P.; Pomahac, Bohdan.

In: Plastic and Reconstructive Surgery, Vol. 136, No. 4, 01.10.2015, p. 839-847.

Research output: Contribution to journalArticle

Janis, JE, Khansa, I, Lehrman, CR, Orgill, DP & Pomahac, B 2015, 'Reconstructive management of devastating electrical injuries to the face', Plastic and Reconstructive Surgery, vol. 136, no. 4, pp. 839-847. https://doi.org/10.1097/PRS.0000000000001619
Janis, Jeffrey E. ; Khansa, Ibrahim ; Lehrman, Craig R. ; Orgill, Dennis P. ; Pomahac, Bohdan. / Reconstructive management of devastating electrical injuries to the face. In: Plastic and Reconstructive Surgery. 2015 ; Vol. 136, No. 4. pp. 839-847.
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