Acute management of facial burns

Introduction

The face is a unique and vitally important structure in humans and plays an irreplaceable role in human life. The face contains the organs of smell, sight, hearing and taste. It is involved in important physiological functions such as vision, respiration, feeding, and hearing but is also vital in communication, transmitting expressions and emotions, feelings and signifying individual identity. It is a complex structure of skin, muscle, fat, vessels, nerves draped around the facial skeleton. A facial burn can vary from being relatively minor to a severely debilitating and disfiguring injury.

Facial burns disrupt the anatomical and functional structures creating swelling, pain, deformity and following wound healing scars that are potentially disfiguring. They can distort anatomical structures and function that can lead to lasting physical and psychological impairment [1].

The management of facial burns includes assessment, airway control, wound management, scar management, rehabilitation and reconstruction [2]. Wound management can be conservative, operative or both, depending on the depth and extent of the burn.

Few areas of burn care can be more challenging than the management of facial burns. The outcome of a facial burn can be critical to a patient’s daily existence and integral to positive self-esteem. The acute

Marc G. Jeschke et al. (eds.), Handbook of Burns

and reconstructive management of facial burns require a thoughtful, methodical treatment plan with the ultimate goal of optimal aesthetic and functional outcomes [3].

Anatomy and pathophysiology

The face is an extremely complex anatomical structure consisting of skin, fat, and muscle, draped over the facial skeleton. It hosts important sphincter structures and vital sensory organs of sight, hearing, smell, taste and touch. Skin acts as a protective barrier against mechanical trauma, bacteria, noxious substances, heat, and ultraviolet radiation. Other important functions include sensation, immunologic surveillance, and heat and fluid homeostasis.

Cutaneous wound healing depends on epithelial cell proliferation and migration following injury from epidermal appendages. These include sebaceous glands, sweat glands, apocrine glands, and hair follicles. The face and scalp contain a high concentration of sebaceous glands and in general epithelial appendages in the facial are located in the deep dermis and in the sub-dermal fat. The deep location of the epithelial appendages and their density in the face provide it with a remarkable ability to re-epithe- lialise and heal spontaneously

In addition the thickness of facial skin varies which can have consequences on the depth of in-

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