Facial Burn, Deep, Full Thickness (3rd degree) Treated with Split Thickness Skin Grafts
Elof Eriksson, MD
History:
34 year old woman comes by ambulance to the ER after sustaining a flame burn to her face one hour earlier. She is alert and oriented and complains of severe facial pain. She is otherwise healthy and her medical history is negative.
Findings:
39 year old woman with charred facial skin and complaining of severe facial pain. The burnt skin is insensate. She is completely alert and oriented. The rest of the examination is unremarkable.
Fig. 1. Patient with full thickness burn.
Diagnosis:
34 year old woman with a full thickness (3rd degree) burn of central face. The burned areas are insensate. She is in severe pain. The rest of the examination is negative.
Differential Diagnoses:
A deep partial thickness burn was considered but this injury was clearly of full thickness.
Workup Required:
Pulse oximetry, physical examination and routine laboratory tests. R/O inhalation injury. Map of the burned areas.
Plan:
Referral to burn center for treatment by burn specialists. The deep facial burn was a clear indication for this.
Expertise Needed:
Burn surgeon with plastic surgery training.
Treatment:
After admission to Burn Center, the burned areas were treated with Silvadene cream. Pain control was given with opioids. It was not possible to determine the extent of the full thickness skin loss then and it was decided to treat the burn conservatively and let it show over time which areas needed skin grafting. A partial surgical debridement was done 6 days postburn and then again 7 days later. Skin grafting was done 20 days postburn. At that time the areas of full thickness burn were covered by thin granulation tissue. All skin grafts showed good take. 4 weeks after grafting, the patient was measured for a compression garment which she wore for 5 months. She was also referred to a beautician for custom designed make up in the scarred areas.
Fig. After application of split thickness skin grafts.
Fig.3. At 3 months she is healed and using covering make up.
Fig. 4. With compression garment to reduce scarring.
Follow Up:
Fig.5. One year after burn.
References
Management of patients with facial burns
Topical treatment for facial burns
Surgical excision of the burn wound
https://pubmed.ucbi.nlm.gov/34654517
https://pubmed.ucbi.nlm.gov/32725896
https://pubmed.uccbi.nlm.gov/19793556