Reconstruction of Postburn Full Facial Deformities With an Integrated Method. 2016

Qing Feng Li, and Tao Zan, and Haizhou Li, and Bin Gu, and Kai Liu, and Feng Xie, and Yun Xie, and Tanja Herrler, and Mathias Tremp, and Shuangbai Zhou, and Xiaolu Huang, and Hainan Zhu
*Department of Plastic and Reconstructive Surgery, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China †Hand, Plastic, and Aesthetic Surgery, Department of General, Trauma, Hand, and Plastic Surgery, University of Munich, Munich, Germany ‡Plastic, Reconstructive, Aesthetic and Handsurgery, University Hospital Basel, Basel, Switzerland.

BACKGROUND The face is one of the most important regions of the human body and contains complicated and delicate features that define the identity of a person. Treatment for extensive facial deformities requires resurfacing of the extensive skin defects and restoring the missing features. To date, it remains a major challenge to the reconstructive surgeons. METHODS The authors reviewed their patients of Type III and Type IV facial deformities to introduce an integrated method for total facial reconstruction. The entire management included flap prefabrication, skin over-expansion, bone marrow mononuclear cell transplantation, and multistaged revisions to reshape the face contours. The treatment details and postoperative results were presented. Aesthetic and functional status scores were independently evaluated to analyze the effectiveness of this intervention. RESULTS Forty-two patients with severe facial deformities were included. In 2 patients of total face reconstruction, bone marrow mononuclear cell transplantation was conducted. Each patient had facial reconstruction with a prefabricated flap (range 23 × 18-32 × 30 cm) that resurfaced the entire defect. Tip necrosis occurred in 2 patients. The aesthetic and functional status scores were statistically improved. Good skin compliance, normal contours, and emotional expression were noted. CONCLUSIONS The integrated method is a reliable and excellent option for extensive facial deformities involving both central and peripheral facial units while avoiding multiflap reconstructions. It creates a desirable coverage with minimal scars, which are both important for a "perceived normal" face.

UI MeSH Term Description Entries
D008297 Male Males
D002056 Burns Injuries to tissues caused by contact with heat, steam, chemicals (BURNS, CHEMICAL), electricity (BURNS, ELECTRIC), or the like. Burn
D005151 Facial Injuries General or unspecified injuries to the soft tissue or bony portions of the face. Injuries, Facial,Facial Injury,Injury, Facial
D005260 Female Females
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000328 Adult A person having attained full growth or maturity. Adults are of 19 through 44 years of age. For a person between 19 and 24 years of age, YOUNG ADULT is available. Adults
D013524 Surgical Flaps Tongues of skin and subcutaneous tissue, sometimes including muscle, cut away from the underlying parts but often still attached at one end. They retain their own microvasculature which is also transferred to the new site. They are often used in plastic surgery for filling a defect in a neighboring region. Island Flap,Island Flaps,Flap, Surgical,Flaps, Surgical,Pedicled Flap,Surgical Flap,Flap, Island,Flap, Pedicled,Flaps, Island,Flaps, Pedicled,Pedicled Flaps
D015361 Rhytidoplasty Plastic surgery performed, usually by excision of skin, for the elimination of wrinkles from the skin. Face Lift,Rhytidectomy,Facelift,Platysmaplasty,Platysmotomy,Face Lifts,Facelifts,Lift, Face,Lifts, Face,Platysmaplasties,Platysmotomies,Rhytidectomies,Rhytidoplasties
D015626 Tissue Expansion A procedure whereby the body is stimulated to generate extra soft tissue by the application of stretching forces that stimulate new growth of tissue which, over a period of time, results in a 2-dimensional expansion of the tissue. The procedure is used in reconstructive surgery for injuries caused by trauma, burns, or ablative surgery. Various types of TISSUE EXPANSION DEVICES have been developed that exert stretching forces. Expansion, Tissue,Expansions, Tissue,Tissue Expansions

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