The Journal of craniofacial surgery
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Despite significant burn treatment advances, modern multidisciplinary care, and improved survival after burns, facial burn scars remain clinically challenging. Achieving a successful reconstruction requires a comprehensive approach, entailing many advanced techniques with an emphasis on preserving function and balancing intricate aesthetic requirements. ⋯ In this paper, we describe the basic principals of facial burn care in the pediatric burn population, with a specific focus on lower-eyelid burn ectropion and oral commissure burn scar contracture leading to microstomia. Several cases are demonstrated.
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Despite major advances in the area of burn management, burn injury continues to be a leading cause of pediatric mortality and morbidity. Facial burns in particular are devastating to the affected child and result in numerous physical and psychosocial sequelae. Although many of the principles of adult burn management can be applied to a pediatric patient with facial burns, the surgeon must be cognizant of several important differences. ⋯ Surgical reconstruction of burn wounds should proceed only after thorough planning and may involve a variety of skin graft, flap, and tissue expansion techniques. The most favorable outcome is achieved when facial resurfacing is performed with respect to the aesthetic units of the face. Children with facial burns remain a considerable challenge to their caregivers, and these patients require long-term care by a multidisciplinary team of physicians and therapists to optimize functional, cosmetic, and psychosocial outcomes.
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Hypertrophic scars and keloids are challenging to manage, particularly as sequelae of burns in children in whom the psychologic burden and skin characteristics differ substantially from adults. Prevention of hypertrophic scars and keloids after burns is currently the best strategy in their management to avoid permanent functional and aesthetical alterations. Several actions can be taken to prevent their occurrence, including parental and children education regarding handling sources of fire and flammable materials, among others. ⋯ Other adjuvant therapies such as topical imiquimod, tacrolimus, and retinoids, as well as intralesional corticosteroids, 5-fluorouracil, interferons, and bleomycin, have been used with relative success. Cryosurgery and lasers have also been reported as alternatives. Newer treatments aimed at molecular targets such as cytokines, growth factors, and gene therapy, currently in developing stages, are considered the future of the treatment of postburn hypertrophic scars and keloids in children.
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Burn injuries continue to be a significant cause of pediatric morbidity in the United States, with approximately 20,000 admissions per year to centers specializing in the treatment of burn injuries. In this article, we aim to provide the practitioner with a guideline to the unique challenges, advances and current expectations, and treatment in this patient population.
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Severe burn injuries frequently present a therapeutic challenge; fortunately, conservative therapies have proven highly effective in augmenting standard surgical management. Skin substitutes, such as pigskin or cadaveric tissue, aid in acute burn care by limiting fluid and heat loss. ⋯ Physical therapy promotes strengthening of local musculature and regain range of motion. We discuss the nonoperative management of severe burns, as well as provide insight into future directions in conservative burn care.