Postcombustional scar deformities of the head and neck at children

Abstract

Introduction: Burnings represent severe trauma injuries both through the development of the skin restitution process and scarring sequelae, often manifested for the rest of the life. A current problem of the pediatric combustiology department is justifying the effective rehabilitation tactic of post-burn convalescent individuals. The vast majority of patients (75%) who suffered from serious burn injuries need conservative treatment, every second patient requiring different reconstructive restorative surgical interventions. The reconstructive and esthetic pediatric surgery at children with postcombustional scar deformities are based on various surgical treatment methods. Purpose and objectives: The assessment of treatment methods applied in removing post-burn scars of the head-neck region at children and estimation of their clinique efficiency. Materials and methods: In this study was analized and investigated a sample of 50 childrens’ medical records with burn injuries with ages ranging from 0-18 years hospitalized in the Public Clinical Hospital “Emilian Cotaga”. Results: The purpose of the reparatory surgical treatment consists in restoring the anatomic structures and creating the optimal physiological conditions for an intact functionality. The treatment techniques depend on precise knowledge of the facial muscles and esthetics, the healing and scarring injury principles, the assessment of the psychological damage as well as an accurate physical examination. The facial scar correction is an unique procedure in the facial-reconstructive surgery due to its unpredictable post-trauma development. For a functional and esthetic effect, at the head-neck region, the following dermatoplasty methods were applied: intact skin grafts plasty, medium-sized dermal splitted transplants, adjacent or distant pedicled flaps plasty. The surgical repair of the dermal defects of the face and neck require a special tactique. In certain cases, the skin transplant and the distant pedicled flaps can be replaced by special treatment methods which use adjacent intact tissue, such as: pedicled flap transposition plasty, expanded tissular flaps plasty of the soft tissues. Following the base surgical principles in the pediatric field is of a high importance. In this way, choosing the adequate surgical method for a specific segment, given its functional and esthetic place, the avoidance of tension stiches are some among other important steps that determine the succesful completion of a high quality treatment. Conclusion: At pediatric ages, the chosen reconstructive surgical method of tissular defects does not depend on the patient’s age, but rather on the localization and nature of the defect, as well as the requirements regarding the functional effects of the respective segement. In most of the cases, in the functional-active regions, methods such as full thickness skin grafts plasty using adjacent intact tissue are applied.