Plastic surgeons perform first entire face reconstruction

Burn victims may soon have face restored with minimal scarring in a single procedure

Hundreds of thousands of people are burned in fires each year with many suffering from facial burns as a result. These burn victims not only have severe physical scars, but deep emotional scars, too. A team of plastic surgeons has successfully combined several reconstructive techniques to help burn victims regain some sense of self without undergoing multiple painful procedures and huge scarring often associated with reconstructing the face, according to a study presented today at the American Society of Plastic Surgeons (ASPS) Plastic Surgery 2004 conference in Philadelphia.

“The difficulty with previous techniques was harvesting a thick, uniform piece of skin and closing the wound where the incision was made, to minimize scarring,” said Thomas Ray Stevenson, MD, president of the Plastic Surgery Educational Foundation and ASPS member. “Through this combination of surgical techniques, a burn patient has only one operation rather than multiple procedures, reducing pain and recovery time.”

In the study, the surgical team used a tissue expander in the back to create a single piece of thick skin, with its own unique blood supply, that would allow for microvascular tissue transfer. Surgeons removed the scarred facial skin, harvested the skin flap from the back, and transferred it to the face. The skin flap was large enough to cover the face completely with extra tissue to create a nose, which otherwise would require a separate surgery. The team closed the donor site on the back without requiring skin grafts from the leg to close the wound, eliminating huge scars that accompanied previous techniques.

Psychologically, burn victims not only have to struggle with their perception of their changed appearance, they also have to deal with how other people perceive them. They often suffer both functional and emotional trauma, which can be alleviated with reconstructive surgery. “Many burn patients who successfully complete facial reconstruction can close their eyes again, relieving the dryness around their eyes,” said Dr. Stevenson. “They stop drooling because their lips have been rebuilt and they can finally smile.”

“By rebuilding the face, they can feel better about themselves and are more accepted socially once their abnormality is less dramatic,” continued Dr. Stevenson. “This procedure is an important step to help burn patients overcome their trauma. As plastic surgeons, we will continue to refine this combination of techniques to help our patients not only rebuild their bodies but also their lives.”