HSC Section 3 - Trauma, Critical Care and Sleep Medicine

Wong et al

Fig. 1. ( A ) Severe flame burn facial scars. ( B ) Radial forearm free flap reconstruction of lower face. ( C ) Early post- operative result. ( D ) Long-term result following multiple revisions and creative make up. ( Courtesy of [ A ] Peter Grossman, MD, West Hills, CA.)

rhomboid flaps ( Fig. 2 ). The new location for the oral commissure should be designed to sit be- tween the medial limbus and midpupillary line to allow for anticipated scar contraction during the healing process. Oral splints should be used once wound healing has ensued to minimize post- operative scar contracture ( Fig. 3 ). 34 Burn contractures of the neck often result even in the presence of prophylactic extension splinting following acute treatment. These can lead to debil- itating functional deformities. At times, these scar contractures need to be addressed during the in- flammatory stages of healing for improved airway access and restoration of oral competency for adequate nutritional intake. Furthermore, neck contractures exert an extrinsic force to distort facial features thus limiting activities of daily living. These include poor speech, drooling, poor oral Neck Reconstruction

be treated by scar release and excision of the entire upper lip aesthetic subunit followed by full- thickness skin grafting. Further reconstruction of philtrum and Cupid’s bow can be accomplished at a later stage. Contracture of the lower lip and chin will lead to lower lip ectropion, loss of oral competence, and excessive drooling. A horizontal scar release or complete scar excision is followed by full-thickness skin grafting of each subunit individually. Microstomia can lead to difficulties with speech, eating, and distortion of facial expression. In chil- dren, dental hygiene difficulties and maxillary or mandibular growth restriction may result from tightness of external facial skin or the use of compression garments during facial growth ages. Commissuroplasty performed for microstomia can involve excision of the scar with full- thickness skin grafting, triangular scar excision with mucosal V-Y advancement flaps, and division of the scar contracture and reconstruction with 2

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