Semin Plast Surg
DOI: 10.1055/s-0044-1786009
Review Article

Pediatric Facial Burn Reconstruction

Tina Moon
1   Department of Surgery, Division of Plastic and Reconstructive Surgery, Massachusetts General Hospital, Boston, Massachusetts
,
Daniel N. Driscoll
2   Department of Plastic and Reconstructive Surgery, Shriners Hospital for Children, Boston, Massachusetts
› Author Affiliations
Funding None.

Abstract

Contrary to prior pediatric burn treatment philosophies, we now know that early burn excision and grafting for non life-threatening burns can compromise future reconstruction. Extensive scar excision should be minimized and scar rehabilitation maximized, as secondary iatrogenic deformities can become even more difficult to fix. Scar remodeling with local tissue rearrangement can relieve tension and soften scars over time. The majority of facial burns often only involve skin and can be adequately treated without the need for complex flap reconstruction. Facial burn scars are a different problem than facial burn scar contracture. The former needs scar rehabilitation, whereas the latter needs the addition of skin. Laser therapy has transformed the treatment of burn scars and is an incredibly valuable adjunct to local tissue rearrangement and grafting. The most favorable functional, aesthetic, and psychological outcomes require a long-term multidisciplinary effort and customized protocol utilizing the vast armamentarium of reconstructive tools described below.



Publication History

Article published online:
26 April 2024

© 2024. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 
  • References

  • 1 Suman A, Owen J. Update on the management of burns in paediatrics. BJA Educ 2020; 20 (03) 103-110
  • 2 Jordan KC, Di Gennaro JL, von Saint André-von Arnim A, Stewart BT. Global trends in pediatric burn injuries and care capacity from the World Health Organization Global Burn Registry. Front Pediatr 2022; 10: 954995
  • 3 Toon MH, Maybauer DM, Arceneaux LL. et al. Children with burn injuries–assessment of trauma, neglect, violence and abuse. J Inj Violence Res 2011; 3 (02) 98-110
  • 4 Hansbrough JFHW, Hansbrough W. Pediatric burns. Pediatr Rev 1999; 20 (04) 117-123 , quiz 124
  • 5 Nguyen TJTS, Thaller S. Psychological rehabilitation of pediatric burn patients. J Craniofac Surg 2008; 19 (04) 882-887
  • 6 Kung TAGA, Gosain AK. Pediatric facial burns. J Craniofac Surg 2008; 19 (04) 951-959
  • 7 Wong S, Melin A, Reilly D. Head and neck reconstruction. Clin Plast Surg 2017; 44 (04) 845-856
  • 8 Sen S. Pediatric inhalation injury. Burns Trauma 2017; 5 (05) 31
  • 9 Malhotra R, Sheikh I, Dheansa B. The management of eyelid burns. Surv Ophthalmol 2009; 54 (03) 356-371
  • 10 Dai T, Huang YY, Sharma SK, Hashmi JT, Kurup DB, Hamblin MR. Topical antimicrobials for burn wound infections. Recent Pat Antiinfect Drug Discov 2010; 5 (02) 124-151
  • 11 Weber J, McManus A. Nursing Committee of the International Society for Burn Injuries. Infection control in burn patients. Burns 2004; 30 (08) A16-A24
  • 12 Klein MB. Burn reconstruction. Phys Med Rehabil Clin N Am 2011; 22 (02) 311-325 , vi–vii
  • 13 Donelan MB. Facial burn treatment principles. In: McCarthy JG GR, Boutros SG. ed. Current Therapy in Plastic Surgery. Saunders; 2006: 184-193
  • 14 Li J, Johnson CA, Smith AA, Shi B, Brunski JB, Helms JA. Molecular mechanisms underlying skeletal growth arrest by cutaneous scarring. Bone 2014; 66: 223-231
  • 15 Fisher M. Pediatric burn reconstruction: focus on evidence. Clin Plast Surg 2017; 44 (04) 865-873
  • 16 Akita S, Hayashida K, Takaki S, Kawakami Y, Oyama T, Ohjimi H. The neck burn scar contracture: a concept of effective treatment. Burns Trauma 2017; 5: 22
  • 17 Pang M, Zhao L, Liu S, Lei Y. Eschar dermabrasion in deep dermal partial-thickness burn: a case report. Adv Skin Wound Care 2023; 36 (07) 1-3
  • 18 Kakagia DDKE, Karadimas EJ. The efficacy of Versajet hydrosurgery system in burn surgery - a systematic review. J Burn Care Res 2018; 39 (02) 188-200
  • 19 Bowers C, Randawa A, Sloan B, Anwar U, Phipps A, Muthayya P. Enzymatic debridement in critically injured burn patients - our experience in the intensive care setting and during burn resuscitation. Burns 2022; 48 (04) 846-859
  • 20 NexoBrid. NexoBrid: educational materials. In: MediWound; 2014
  • 21 Schulz A, Fuchs PC, Rothermundt I. et al. Enzymatic debridement of deeply burned faces: healing and early scarring based on tissue preservation compared to traditional surgical debridement. Burns 2017; 43 (06) 1233-1243
  • 22 Shoham Y, Krieger Y, Rubin G. et al. Rapid enzymatic burn debridement: a review of the paediatric clinical trial experience. Int Wound J 2020; 17 (05) 1337-1345
  • 23 Shahrokhi S, Arno A, Jeschke MG. The use of dermal substitutes in burn surgery: acute phase. Wound Repair Regen 2014; 22 (01) 14-22
  • 24 Nguyen DQAPT, Potokar TS, Price P. An objective long-term evaluation of Integra (a dermal skin substitute) and split thickness skin grafts, in acute burns and reconstructive surgery. Burns 2010; 36 (01) 23-28
  • 25 Ruszczak Z. Effect of collagen matrices on dermal wound healing. Adv Drug Deliv Rev 2003; 55 (12) 1595-1611
  • 26 Klein MB, Engrav LH, Holmes JH. et al. Management of facial burns with a collagen/glycosaminoglycan skin substitute-prospective experience with 12 consecutive patients with large, deep facial burns. Burns 2005; 31 (03) 257-261
  • 27 Lohana P, Hassan S, Watson SB. Integra™ in burns reconstruction: our experience and report of an unusual immunological reaction. Ann Burns Fire Disasters 2014; 27 (01) 17-21
  • 28 Seth AKRI, Ratanshi I, Dayan JH, Disa JJ, Mehrara BJ. Nasal reconstruction using the Integra dermal regeneration template. Plast Reconstr Surg 2019; 144 (04) 966-970
  • 29 Bascone CRL, Nugent ST, Mcgraw JR. et al. Utilizing Integra for reconstruction of facial defects after Mohs micrographic surgery. Plast Reconstr Surg Glob Open 2023; 11 (4s): 44-45
  • 30 Thorne CH, Chung KC, Gosain AK. et al Techniques and principles in plastics surgery. Grabb and Smith's Plastic Surgery: 7th ed. Philadelphia, PA: Lippincott Williams & Wilkins; 2014: 1-12
  • 31 Braza ME, Fahrenkopf MP. Split thickness skin grafts. In: StatPearls. Treasure Island (FL): StatPearls Publishing; 2023
  • 32 Driscoll D. Pediatric reconstruction of the burned face. In. Thall Symposium: Shriners Hospital for Children Boston 2023
  • 33 Sherman R, Rosenfeld H. Experience with the Nd:YAG laser in the treatment of keloid scars. Ann Plast Surg 1988; 21 (03) 231-235
  • 34 Hulsbergen Henning JPRY, Roskam Y, van Gemert MJ. Treatment of keloids and hypertrophic scars with an argon laser. Lasers Surg Med 1986; 6 (01) 72-75
  • 35 Parrett BMDM, Donelan MB. Pulsed dye laser in burn scars: current concepts and future directions. Burns 2010; 36 (04) 443-449
  • 36 Reiken Sr SR, Wolfort SF, Berthiaume F, Compton C, Tompkins RG, Yarmush ML. Control of hypertrophic scar growth using selective photothermolysis. Lasers Surg Med 1997; 21 (01) 7-12
  • 37 Alster T, Zaulyanov L. Laser scar revision: a review. Dermatol Surg 2007; 33 (02) 131-140
  • 38 Anderson RRPJ, Parrish JA. Selective photothermolysis: precise microsurgery by selective absorption of pulsed radiation. Science 1983; 220 (4596) 524-527
  • 39 Bailey JKBS, Burkes SA, Visscher MO. et al. Multimodal quantitative analysis of early pulsed-dye laser treatment of scars at a pediatric burn hospital. Dermatol Surg 2012; 38 (09) 1490-1496
  • 40 Allison KPKM, Kiernan MN, Waters RA, Clement RM. Pulsed dye laser treatment of burn scars. Alleviation or irritation?. Burns 2003; 29 (03) 207-213
  • 41 Bowes LENK, Nouri K, Berman B. et al. Treatment of pigmented hypertrophic scars with the 585 nm pulsed dye laser and the 532 nm frequency-doubled Nd:YAG laser in the Q-switched and variable pulse modes: a comparative study. Dermatol Surg 2002; 28 (08) 714-719
  • 42 Donelan MBPB, Parrett BM, Sheridan RL. Pulsed dye laser therapy and Z-plasty for facial burn scars: the alternative to excision. Ann Plast Surg 2008; 60 (05) 480-486
  • 43 Kono T, Erçöçen AR, Nakazawa H, Nozaki M. Treatment of hypertrophic scars using a long-pulsed dye laser with cryogen-spray cooling. Ann Plast Surg 2005; 54 (05) 487-493
  • 44 Manuskiatti W, Wanitphakdeedecha R, Fitzpatrick RE. Effect of pulse width of a 595-nm flashlamp-pumped pulsed dye laser on the treatment response of keloidal and hypertrophic sternotomy scars. Dermatol Surg 2007; 33 (02) 152-161
  • 45 Dierickx C, Goldman MP, Fitzpatrick RE. Laser treatment of erythematous/hypertrophic and pigmented scars in 26 patients. Plast Reconstr Surg 1995; 95 (01) 84-90 , discussion 91–92
  • 46 El-Zawahry Sr BM, Sobhi RM, Bassiouny DA, Tabak SA. Ablative CO2 fractional resurfacing in treatment of thermal burn scars: an open-label controlled clinical and histopathological study. J Cosmet Dermatol 2015; 14 (04) 324-331
  • 47 Choi KJWE, Williams EA, Pham CH. et al. Fractional CO2 laser treatment for burn scar improvement: a systematic review and meta-analysis. Burns 2021; 47 (02) 259-269
  • 48 Willows BMIM, Ilyas M, Sharma A. Laser in the management of burn scars. Burns 2017; 43 (07) 1379-1389
  • 49 Lee SJ, Kim JH, Lee SE, Chung WS, Oh SH, Cho SB. Hypertrophic scarring after burn scar treatment with a 10,600-nm carbon dioxide fractional laser. Dermatol Surg 2011; 37 (08) 1168-1172
  • 50 Piccolo NS, Piccolo MS, de Paula Piccolo N. et al. Fat grafting for treatment of facial burns and burn scars. Clin Plast Surg 2020; 47 (01) 119-130
  • 51 Klinger M, Klinger F, Caviggioli F. et al. Fat grafting for treatment of facial scars. Clin Plast Surg 2020; 47 (01) 131-138
  • 52 Neumann CG. The expansion of an area of skin by progressive distension of a subcutaneous balloon; use of the method for securing skin for subtotal reconstruction of the ear. Plast Reconstr Surg 1957; 19 (02) 124-130
  • 53 Hudson DAGA, Grobbelaar AO. The use of tissue expansion in children with burns of the head and neck. Burns 1995; 21 (03) 209-211
  • 54 Khalatbari B, Bakhshaeekia A. Ten-year experience in face and neck unit reconstruction using tissue expanders. Burns 2013; 39 (03) 522-527
  • 55 Motamed S, Niazi F, Atarian S, Motamed A. Post-burn head and neck reconstruction using tissue expanders. Burns 2008; 34 (06) 878-884
  • 56 McCullough MC, Roubard M, Wolfswinkel E, Fahradyan A, Magee W. Ectropion in facial tissue expansion in the pediatric population: incidence, risk factors, and treatment options. Ann Plast Surg 2017; 78 (03) 280-283
  • 57 Neale HWKL, Kurtzman LC, Goh KB, Billmire DA, Yakuboff KP, Warden G. Tissue expanders in the lower face and anterior neck in pediatric burn patients: limitations and pitfalls. Plast Reconstr Surg 1993; 91 (04) 624-631
  • 58 Daugherty THF, Pribaz JJ, Neumeister MW. The use of prefabricated flaps in burn reconstruction. Clin Plast Surg 2017; 44 (04) 813-821
  • 59 Baumeister S, Köller M, Dragu A, Germann G, Sauerbier M. Principles of microvascular reconstruction in burn and electrical burn injuries. Burns 2005; 31 (01) 92-98
  • 60 Seth AK, Friedstat JS, Orgill DP, Pribaz JJ, Halvorson EG. Microsurgical burn reconstruction. Clin Plast Surg 2017; 44 (04) 823-832
  • 61 Ridgway EBCJ, Cowan JB, Donelan MB, Driscoll DN. Pediatric burn-related scalp alopecia treated with tissue expansion and the incidence of associated facial burn injuries. J Burn Care Res 2010; 31 (03) 409-413
  • 62 Fernandes Jr JR, Driscoll DN. Burn ear reconstruction using porous polyethylene implants and tissue expansion. J Burn Care Res 2016; 37 (04) e348-e352
  • 63 Spence RJ. An algorithm for total and subtotal facial reconstruction using an expanded transposition flap: a 20-year experience. Plast Reconstr Surg 2008; 121 (03) 795-805
  • 64 DePamphilis MADR, Dabek RJ, Sheridan RL, Bojovic B, Driscoll DN. Antegrade foreheadplasty: a novel surgical approach for upper eyelid contracture deformities in pediatric patients. J Craniofac Surg 2020; 31 (08) 2199-2203
  • 65 Grabosch A, Weyer F, Gruhl L, Bruck JC. Repair of the upper eyelid by means of the prepuce after severe burns. Ann Plast Surg 1991; 26 (05) 427-430
  • 66 Egeland B, More S, Buchman SR, Cederna PS. Management of difficult pediatric facial burns: reconstruction of burn-related lower eyelid ectropion and perioral contractures. J Craniofac Surg 2008; 19 (04) 960-969
  • 67 Jiaqi C, Zheng W, Jianjun G. Eyelid reconstruction with acellular human dermal allograft after chemical and thermal burns. Burns 2006; 32 (02) 208-211
  • 68 Ridgway EB, Pribaz JJ. The reconstruction of male hair-bearing facial regions. Plast Reconstr Surg 2011; 127 (01) 131-141
  • 69 King IC, Nikkhah D, Martin NA, Gilbert PM, Dheansa BS. Nasal reconstruction in panfacial burns: useful techniques in challenging cases. Ann Plast Surg 2014; 73 (06) 638-639
  • 70 Bouguila J, Ho Quoc C, Viard R. et al. Nose burns: 4-dimensional analysis. Eur Ann Otorhinolaryngol Head Neck Dis 2017; 134 (05) 333-337
  • 71 Taylor HO, Carty M, Driscoll D, Lewis M, Donelan MB. Nasal reconstruction after severe facial burns using a local turndown flap. Ann Plast Surg 2009; 62 (02) 175-179
  • 72 Grishkevich VM. Postburn philtrum and upper lip reconstruction. Plast Reconstr Surg 2010; 125 (01) 10e-12e
  • 73 Roh DS, Bojovic B, Woolard AC, Donelan MB. Triangular fossa graft for philtral reconstruction after facial burns: a 34-year experience. Ann Plast Surg 2020; 84 (02) 144-148
  • 74 Uglesic V, Amin K, Dediol E, Kosutic D. Combined Karapandzic-Abbé/Estlander/Stein flap for subtotal and total lower lip reconstruction. J Plast Reconstr Aesthet Surg 2019; 72 (03) 484-490
  • 75 Donelan MB. Reconstruction of electrical burns of the oral commissure with a ventral tongue flap. Plast Reconstr Surg 1995; 95 (07) 1155-1164
  • 76 Levi B, Ricci JA, Donelan MB. Vermillion reconstruction with anal verge transitional epithelium: turning things upside down. J Burn Care Res 2018; 39 (02) 218-223
  • 77 Ma X, Li Y, Li W. et al. Reconstruction of large postburn facial-scalp scars by expanded pedicled deltopectoral flap and random scalp flap: technique improvements to enlarge the reconstructive territory. J Craniofac Surg 2017; 28 (06) 1526-1530
  • 78 Abouchadi A, Capon-Degardin N, Patenôtre P, Martinot-Duquennoy V, Pellerin P. The submental flap in facial reconstruction: advantages and limitations. J Oral Maxillofac Surg 2007; 65 (05) 863-869
  • 79 Gan C, Fan J, Liu L. et al. Reconstruction of large unilateral hemi-facial scar contractures with supercharged expanded forehead flaps based on the anterofrontal superficial temporal vessels. J Plast Reconstr Aesthet Surg 2013; 66 (11) 1470-1476
  • 80 Vinh VQ, Van Anh T, Gia Tiên N, Hyakusoku H, Ogawa R. Reconstruction of neck and face scar contractures using occipito-cervico-dorsal supercharged “super-thin flaps”: a retrospective analysis of 82 cases in Vietnam. Burns 2018; 44 (02) 462-467
  • 81 Hyakusoku H, Gao JH. The “super-thin” flap. Br J Plast Surg 1994; 47 (07) 457-464
  • 82 Buta MBB, DePamphilis M, Driscoll DN, Ehrlichman R. A classification system and surgical algorithm for pediatric postburn ear deformities. J Burn Care Res 2023; 44: S195
  • 83 Ray E, Wu T, Nazarian Mobin SS, Reinisch J, Urata MM. Review of options for burned ear reconstruction. J Craniofac Surg 2010; 21 (04) 1165-1169
  • 84 Mutaf M, Isk D, Atik B, Bulut O. Versatility of the bilobed cervical skin flap for total ear reconstruction in the unfavorable temporoauriculomastoid region. Plast Reconstr Surg 2006; 118 (03) 652-662
  • 85 Donelan MB. Conchal transposition flap for postburn ear deformities. Plast Reconstr Surg 1989; 83 (04) 641-654
  • 86 Giatsidis G, Sinha I, Pomahac B. Relfections on a decade of face transplantation. Ann Surg 2017; 265 (04) 841-846
  • 87 Arno A, Barret JP, Harrison RA, Jeschke MG. Face allotransplantation and burns: a review. J Burn Care Res 2012; 33 (05) 561-576
  • 88 Bharadia D, Sinha I, Pomahac B. Role of facial vascularized composite allotransplantation in burn patients. Clin Plast Surg 2017; 44 (04) 857-864